Lifeguarding Blended Learning Instructor’s Manual (Updated November 2019)

Lifeguarding
BLENDED LEARNING
INSTRUCTOR’S MANUAL
American Red Cross
Lifeguarding
Blended Learning
Instructor’s Manual
This instructor’s manual is part of the American Red Cross Lifeguarding program. Visit
redcross.org to learn more about this program.
The emergency care procedures outlined in this book reflect the standard of knowledge
and accepted emergency practices in the United States at the time this book was
published. It is the reader’s responsibility to stay informed of changes in emergency
care procedures.
The following materials (including downloadable electronic materials, as applicable),

including all content, graphics, images and logos, are copyrighted by, and the exclusive
property of, The American National Red Cross (“Red Cross”). Unless otherwise
indicated in writing by the Red Cross, the Red Cross grants you (“Recipient”) the
limited right to download, print, photocopy and use the electronic materials only for use
in conjunction with teaching or preparing to teach a Red Cross course by individuals or
entities expressly authorized by the Red Cross, subject to the following restrictions:
■■ The Recipient is prohibited from creating new electronic versions of the materials.
■■ The Recipient is prohibited from revising, altering, adapting or modifying the

materials, which includes removing, altering or covering any copyright notices,
Red Cross marks, logos or other proprietary notices placed or embedded in the
materials.
■■ The Recipient is prohibited from creating any derivative works incorporating, in part
or in whole, the content of the materials.
■■ The Recipient is prohibited from downloading the materials, or any part of the
materials, and putting them on the Recipient’s own website or other third-party
website without advance written permission of the Red Cross.
■■ The Recipient is prohibited from removing these Terms and Conditions in

otherwise-permitted copies, and is likewise prohibited from making any additional
© 2011, 2017, 2019 The American National Red Cross. All rights reserved.
representations or warranties relating to the materials.
To request permission to reproduce or publish Red Cross materials, please submit an

initial written request to The American National Red Cross by going to
redcross.org > Contact Us > General Inquiry form and our Public Inquiry unit will reply
with our copyright permission request form.
Copyright © 2011, 2017, 2019 The American National Red Cross. ALL RIGHTS
RESERVED.
Updated in 2019 to reflect administrative changes for instructors and instructor trainers,
including the launch of a new learning management system—the Red Cross Learning
Center.
The Red Cross emblem, American Red Cross® and the American Red Cross logo are
registered trademarks of The American National Red Cross and protected by various
national statutes.
Printed in the United States of America
ISBN: 978-0-9983745-2-9
ii Lifeguarding | Blended Learning Instructor’s Manual

Acknowledgments
The American Red Cross Lifeguarding Blended Learning Instructor’s Manual
was developed through the dedication of both employees and volunteers. Their
commitment to excellence made this manual possible.
The following members of the American Red Cross Scientific Advisory

Council provided guidance and review of the American Red Cross
Lifeguarding Blended Learning Instructor’s Manual:
David Markenson, MD, MBA, FCCM, FAAP,

FACEP, EMT-P
Chair, American Red Cross Scientific Advisory Council
Chief Medical Officer, Sky Ridge Medical Center
Denver, Colorado
Peter G. Wernicki, MD, FAAOS

Aquatics Chair, American Red Cross Scientific Advisory Council
Sports Medicine Orthopedic Surgeon
Assistant Clinical Professor, Florida State School of Medicine
Chair, International Lifesaving Federation Medical Committee
U.S. Lifesaving Association Medical Advisor
Vero Beach, Florida
Roy Fielding, MS
Member, American Red Cross Scientific Advisory Council
Senior Lecturer, Department of Kinesiology
University of North Carolina at Charlotte
Charlotte, North Carolina
Teresa (Terri) Lees, MS

Owner, Lees Therapeutic Solutions
Talees LLC
Wichita, Kansas
Linda Quan, MD, FAAP

Vice Chair, American Red Cross Scientific Advisory Council
Pediatric Emergency Physician, Seattle Children’s Hospital
Professor of Pediatrics at the University of Washington School of Medicine
Seattle, Washington
Joshua M. Tobin, MD
Director, Trauma Anesthesiology, Keck School of Medicine at USC
Los Angeles, California
iii Lifeguarding | Blended Learning Instructor’s Manual

The following members of the American Red Cross Scientific Advisory
Council provide support and guidance on American Red Cross
Swimming and Water Safety programs:
Angela Beale, PhD

Louise Kublick, BS
Stephen Langendorfer, PhD
William D. Ramos, PhD
For more information on the Scientific Advisory Council, visit

redcross.org/science.
The American Red Cross thanks:

Francesco (Frank) Pia, PhD, emeritus member of the Scientific Advisory
Council, Alex Antoniou, PhD, Chief Marketing and Information Officer, National
Swimming Pool Foundation and Jerome H. Modell, MD, emeritus Professor of
Anesthesiology, Colleges of Medicine and Veterinary Medicine, University of
Florida, for their contributions to this manual.
iv Lifeguarding | Blended Learning Instructor’s Manual

The panel of volunteer subject matter experts for this edition includes:
Joshua D. Aldama
Operations Manager
Aquatica San Antonio, SeaWorld Parks & Entertainment
San Antonio, Texas
Algreatus Batton, AFO

Assistant Aquatics Operations Manager
City of Charlottesville Parks and Recreation
Charlottesville, Virginia
David W. Bell, PhD

National Aquatics Task Force
Boy Scouts of America
Ponca City, Oklahoma
Branden Burns
Aquatics Coordinator
Twinsburg Parks and Recreation
Twinsburg, Ohio
Pete DeQuincy
Aquatics Manager
East Bay Regional Park District
Oakland, California
Mary Franklin
Volunteer Instructor Trainer Educator
American Red Cross
Knoxville, Tennessee
Cory Hilderbrand
Aquatics Supervisor
City of Irvine
Irvine, California
Karen M. Jenovese
Owner, Swim New Hampshire LLC
Concord, New Hampshire
Dan Jones
Division Head of Aquatics and Beaches
City of Norfolk, Virginia
William A.J. Kirkner, JD

Senior Director, Aquatics Facilities and Programs
JCC of Greater Baltimore
Owings Mills, Maryland
Daniel Llanas
Director of Operations
Aquatica San Antonio, SeaWorld Parks & Entertainment
San Antonio, Texas
John Raby
President
Minnesota Safety Services, LLC
Excelsior, Minnesota
v Lifeguarding | Blended Learning Instructor’s Manual

Billy Sassi
Aquatics Manager
Tucson Parks and Recreation Department
Tucson, Arizona
Sean E. Sepela
Aquatic Operations Manager
Freedom Aquatic & Fitness Center
George Mason University
Manassas, Virginia
Ginny Templeton, MA
Associate Director of Operations
Associated Students Inc., California State Polytechnic University
Pomona, California
Jason D. Vitulli
Aquatic Program Coordinator
Town of Hempstead
Hempstead, New York
Brenda J. Ward
Lecturer, Department of Kinesiology
University of North Carolina at Charlotte
Charlotte, North Carolina
Christopher R. Whipple, AqP

Manager of Lifeguards
University of Maryland
College Park, Maryland
vi Lifeguarding | Blended Learning Instructor’s Manual

Lifeguarding Content
Direction
Stephanie Shook, CPRP
Senior Manager, Instructor Engagement and Quality Assurance
Lifeguarding Content and Instructional Design Director
American Red Cross
Catherine Barry
National Director, Aquatics
American Red Cross
Jonathan Epstein
Senior Director, Science and Content Development
American Red Cross
Connie Harvey
National Director, Centennial Initiatives
American Red Cross
Matthew Haynes
Product Manager, Aquatics
American Red Cross
Nichole Steffens
Product Manager, Aquatics
Lifeguarding Project Manager
American Red Cross
Special Thanks
Special thanks to:
Lindsay O’Donnell, for her assistance in reviewing the Instructor’s Manual and
developing supplementary materials; Emma Reeners, Suzanne Ries and the
lifeguarding staff at Florida Gulf Coast University; Mike Penzato, Pete Kekes
and the lifeguarding staff from Adventure Island Waterpark and SeaWorld Parks
and Entertainment; Kayla Carpentier, Jeremy Hall and the lifeguarding staff at
Three Oaks Recreation Area, Crystal Lake; Octavio Carbajal and the lifeguards
from Blue Island Park District, New York State Office of Parks, Recreation and
Historic Preservation, the New York State Parks Water Safety Bureau and
Parks Management, and lifeguards from Riverbank and Roberto Clemente state
parks; Bill Kirkner, Mark Bonitabus, Sue Szembroth and the lifeguarding staff of
the JCC of Greater Baltimore; Mike McGoun and the lifeguarding staff of the
Coral Springs Aquatic Center; Angela Lorenzo-Clavell and the City of Chandler
lifeguarding staff for opening their facilities to us for photography and video
shoots. We would also like to express our appreciation to Simon Bruty, the Little
Cabin Films crew, the Canadian Red Cross and the many volunteers who made
the photos and videos a reality.
vii Lifeguarding | Blended Learning Instructor’s Manual

Table of Contents
Section A:
Program Administration
INTRODUCTION
Chapter 1: Program Overview . . . . . . . . . . . . . 2

Chapter 2: Becoming an American
Red Cross Instructor . . . . . . . . . . . . . . . . . . . 13
Chapter 3: Setting Up and Running
Courses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Chapter 4: Teaching So That Every
Participant Can Learn . . . . . . . . . . . . . . . . . . 22
Chapter 5: Conducting Effective Skill
Sessions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Chapter 6: Course Completion . . . . . . . . . . . . 33
Section B:
The Courses
LIFEGUARDING BLENDED LEARNING LESSON 1

COURSE OUTLINES
The Professional Lifeguard . . . . . . . . . . . . . . . 64
Extended Outline . . . . . . . . . . . . . . . . . . . . . . . . 38 Introduction to the Course . . . . . . . . . . . . . . . 65
Intensive Outline . . . . . . . . . . . . . . . . . . . . . . . . 46 Being Part of a Team . . . . . . . . . . . . . . . . . . . . 67
PRECOURSE SESSION LESSON 2
Precourse Session . . . . . . . . . . . . . . . . . . . . . . 52
Facility Safety and Patron Surveillance . . . . 70
Introduction to the Precourse Session . . . . . 54
Facility Safety and the Drowning Process . . 72
Verification of Age Prerequisite . . . . . . . . . . . 56
In-Water Skill Session: Entries and
Prerequisite Swimming Skills Evaluation . . . 57
Approaches . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
Wrap-Up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60
Skill Charts and Assessment Tools . . . . . . . . 74
Skill Chart and Skill Assessment Tool . . . . . 61
ix Lifeguarding | Blended Learning Instructor’s Manual

Section B:
The Courses (cont.)
LESSON 3 LESSON 5
Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . 76 Before Providing Care, Victim Assessment

Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . 78 and Breathing Emergencies . . . . . . . . . . . 108
In-Water Skill Session: Victim Recognition Standard Precautions . . . . . . . . . . . . . . . . . . . 111
General Procedures for an Emergency
and Lifeguarding Rotations . . . . . . . . . . . . . 78 on Land . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111
Putting It All Together . . . . . . . . . . . . . . . . . . . . 80 Performing a Primary Assessment . . . . . . . 112
Moving a Victim . . . . . . . . . . . . . . . . . . . . . . . . 115
LESSON 4 Recognizing and Caring for Breathing
Emergencies . . . . . . . . . . . . . . . . . . . . . . . . 116
Water Rescue Skills . . . . . . . . . . . . . . . . . . . . . 84 Giving Ventilations . . . . . . . . . . . . . . . . . . . . . 117
In-Water Skill Session—Rescue Skills Giving Ventilations Using a
Bag-Valve-Mask Resuscitator . . . . . . . . . . 119
Part 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86
Airway Obstruction . . . . . . . . . . . . . . . . . . . . . 120
Putting It All Together: EAP Activity . . . . . . . . 89
Skill Charts and Assessment Tools . . . . . . . 122
In-Water Skill Session—Rescue Skills,
Part 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90
Putting It All Together . . . . . . . . . . . . . . . . . . . . 93
Skill Charts and Assessment Tools . . . . . . . . 95
x Lifeguarding | Blended Learning Instructor’s Manual

Section B:
The Courses (cont.)
LESSON 6 LESSON 8
Cardiac Emergencies and Using an

Automated External Defibrillator . . . . . . . 130 Head, Neck and Spinal Injuries
in the Water . . . . . . . . . . . . . . . . . . . . . . . . . . 172
Cardiac Arrest . . . . . . . . . . . . . . . . . . . . . . . . . 133
Caring for Head, Neck and Spinal Injuries
CPR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 in the Water . . . . . . . . . . . . . . . . . . . . . . . . . . 174
Two-Rescuer CPR—Adult and Child . . . . . . 137 In-Water Skill Session: Head, Neck and
When the Heart Stops . . . . . . . . . . . . . . . . . . 138 Spinal Injuries . . . . . . . . . . . . . . . . . . . . . . . 175
Using an AED . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Skill Charts and Assessment Tools . . . . . . . 177
CPR with Airway Obstruction . . . . . . . . . . . . 140
In-Water Skill Session:
Putting It All Together . . . . . . . . . . . . . . . . . . . 141 LESSON 9
Putting It All Together: Multiple-Rescuer
Response . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Final Written Exam and Final In-Water
Skill Charts and Assessment Tools . . . . . . . 145 Skill Scenarios . . . . . . . . . . . . . . . . . . . . . . . 186
Final Written Exam: Section 2—
Lifeguarding Skills . . . . . . . . . . . . . . . . . . . 188
In-Water Skill Session:
LESSON 7 General Water Skills (Optional) . . . . . . . . 188
Final In-Water Skill Scenarios . . . . . . . . . . . 189
First Aid . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Closing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191
Secondary Assessment . . . . . . . . . . . . . . . . . 154
Responding to Injuries . . . . . . . . . . . . . . . . . . 155
Putting It All Together:
First Aid Scenarios . . . . . . . . . . . . . . . . . . . . 158
When Things Do Not Go as Practiced . . . . . 164
In-Water Skill Session: Rescue Skills
Review . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Skill Charts and Assessment Tools . . . . . . . 166
xi Lifeguarding | Blended Learning Instructor’s Manual

Section C:
Appendices
Appendix A: Sample Letters . . . . . . . . . . . . . 194 Appendix F: About the Science . . . . . . . . . . 236

Appendix B: Activity Resources . . . . . . . . . . 200 Appendix G: Written Exam Answer
Appendix C: Lifeguarding Video Keys and Answer Sheets . . . . . . . . . . . . . . 240
Segments . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 Appendix H: Participant’s Manual Chapter
Appendix D: Common Participant Review Answer Keys . . . . . . . . . . . . . . . . . 248
Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218
Appendix E: Participant Progress Log and
Multiple-Rescuer Response Assessment
Tools . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224
Section D:
Aquatic Attraction Lifeguarding
Aquatic Attraction Lifeguarding (Water ≤ 3’)

Skill Charts and Assessment Tools . . . . . 306
xii Lifeguarding | Blended Learning Instructor’s Manual

CHAPTER 1
SECTION A PROGRAM
| ADMINISTRATION
PROGRAM OVERVIEW
Program Purpose
The primary purpose of the American Red Cross Blended Lifeguarding course is to provide entry-
level lifeguard participants with the knowledge and skills to prevent, recognize and respond to aquatic
emergencies and to provide professional-level care for breathing and cardiac emergencies, injuries
and sudden illnesses until emergency medical services (EMS) personnel take over. This program offers
a choice of Lifeguarding/First Aid/CPR/AED courses to meet the various training needs of a diverse
audience.
The care steps outlined within this manual are consistent with the 2015 International Liaison Committee
on Resuscitation (ILCOR), Consensus on Science and Treatment Recommendations for CPR and
Emergency Cardiovascular Care (ECC) and the 2015 American Heart Association and American Red
Cross Guidelines for First Aid. This manual also reflects the United States Lifeguarding Standards: A
Review and Report of the United States Lifeguard Standards Coalition, a collaborative effort of the
American Red Cross, the United States Lifesaving Association and the YMCA of the USA.
Program Objectives
It is your responsibility as an instructor to make sure participants meet the learning objectives listed at
the beginning of each lesson in this manual, and achieve the American Red Cross Lifeguarding program
benchmarks. The following are program objectives:
■■ Meet the age requirement.
■■ Demonstrate proficiency in all of the prerequisite skills.
■■ Describe the characteristics and responsibilities of a professional lifeguard.
■■ Explain how to fulfill the responsibilities of a professional lifeguard.
■■ Define certain legal considerations and apply them to situations that might be encountered in
lifeguarding.
■■ Describe ongoing training for lifeguards.
■■ Describe what it means to work as part of a lifeguard and safety team.
■■ Describe the role lifeguards play in ensuring facility safety.
■■ Identify how to ensure the safety of patrons when weather conditions create safety concerns.
■■ Describe the role that facility management plays in facility safety.
■■ Describe the drowning process.
■■ Identify the behaviors of a swimmer, distressed swimmer, and an active and a passive victim.
■■ Identify and define elements of effective surveillance.
■■ Explain proper scanning techniques and identify tactics to overcome scanning challenges.
■■ Identify various types of zones of surveillance.
■■ Explain how communication with patrons plays a role in preventing injuries.
■■ Explain patron surveillance techniques for various activities.
■■ Explain patron surveillance techniques for facilities with special attractions.
■■ Explain and demonstrate lifeguard rotations.
2 Lifeguarding | Blended Learning Instructor’s Manual

■■ Demonstrate how to perform effective surveillance including scanning, victim recognition and
lifeguard rotations.
■■ Explain various types of drills that test lifeguard zones, recognition and response.
■■ Explain patron surveillance techniques for organized groups.
■■ Explain the purpose and general procedures of an emergency action plan (EAP).
■■ Demonstrate how to safely and effectively assist a distressed swimmer, rescue an active and a
passive victim and rescue multiple victims.
■■ Demonstrate the ability to implement an EAP and perform a rescue.
■■ Demonstrate how to safely and effectively rescue a submerged victim in shallow or deep water.
■■ Demonstrate how to safely and effectively perform feet-first and head-first surface dives (Lifeguarding
course only).
■■ Demonstrate how to safely and effectively extricate an unresponsive victim from the water using a
backboard.
■■ Demonstrate how to put on gloves in a wet environment.
■■ Describe what standard precautions to take to prevent disease transmission when providing care.
■■ Demonstrate proper removal of disposable gloves.
■■ Describe the general procedures for injury or sudden illness on land.
■■ Identify items of concern when performing a scene size-up and forming an initial impression.
■■ Demonstrate how to perform a primary assessment for adults, children and infants and place a victim
in a recovery position.
■■ Identify victim conditions that indicate the need to summon emergency medical services (EMS)
personnel.
■■ Understand how to safely and effectively move a victim on land.
■■ Demonstrate how to use a resuscitation mask.
■■ Recognize and care for a breathing emergency.
■■ Demonstrate how to safely and effectively give ventilations.
■■ Demonstrate how to safely and effectively use a bag-valve-mask (BVM) resuscitation with two
rescuers.
■■ Demonstrate how to safely and effectively care for an obstructed airway for a responsive and an
unresponsive victim.
■■ Demonstrate the ability to work as a team to implement an EAP, perform a rescue and perform
emergency care.
■■ Identify the five links in the Adult and Pediatric Cardiac Chain of Survival and identify the importance
of each.
■■ Recognize the signs of a heart attack.
■■ Identify the steps for caring for a victim of a heart attack.
■■ Identify signs and symptoms of cardiac arrest.
■■ Demonstrate how to safely and effectively perform one-rescuer CPR and two-rescuer CPR.
■■ Demonstrate how to use an automated external defibrillator (AED).
■■ Identify precautions for using an AED.
■■ Demonstrate how to perform a secondary assessment.
■■ Identify how to recognize and care for a victim of sudden illness, injuries and shock.
■■ Demonstrate how to control external bleeding.
■■ Identify how to recognize and care for a victim of poisoning, heat-related illnesses and cold-related
emergencies.
■■ Demonstrate the ability to work as a team to implement an EAP, perform a secondary assessment
and provide first aid care.
■■ Identify possible causes of head, neck or spinal injuries on land.
■■ Identify signs and symptoms of head, neck or spinal injuries.
■■ Demonstrate how to care for victims with head, neck or spinal injuries on land.
■■ Demonstrate how to perform front and rear head-hold escapes.
■■ Demonstrate how to give in-water ventilations.
■■ Demonstrate how to perform a quick extrication of a victim from the water.
■■ Demonstrate how to care for victims with head, neck or spinal injuries in shallow and deep water.

■■ Demonstrate how to care for victims with head, neck or spinal injuries in shallow water only (Shallow
Water Lifeguarding and Aquatic Attraction Lifeguarding).
■■ Demonstrate how to care for a victim with a head, neck or spinal injury in shallow water.
■■ Demonstrate how to rescue an active victim in deep water.
■■ Demonstrate how to rescue a submerged passive victim in deep water and provide care.
■■ Demonstrate how to rescue an active victim in shallow water (Shallow Water Lifeguarding only).
■■ Demonstrate how to rescue a submerged passive victim in shallow water and provide care (Shallow
Water Lifeguarding only).
PROGRAM PARTICIPANTS
The intended audience for the courses in this program includes individuals who will work as lifeguards.
The participants may be taking this training outside the traditional academic environment of a high
school, college or university. Successful instructors understand participants’ background and motivation
and may modify their teaching style (not the course) accordingly.
■■ Participants could represent a broad range of backgrounds.

■■ They may differ in age or levels of maturity.
■■ They may differ in levels of education or experience.
■■ They are likely taking these courses to fulfill employment requirements.
■■ They may be taking these courses to provide for the safety and well-being of their friends, family and
community or for personal satisfaction.
PROGRAM PREREQUISITES
■■ Entry into the American Red Cross Lifeguarding course is strictly limited to those who meet the
minimum age requirement and have successfully completed the prerequisite skills evaluation. Failure
to have attained the appropriate skill level could pose a safety threat to themselves and to others in
the class.
■■ Participants in the Lifeguarding program must be 15 years of age on or before the last scheduled
session of the course. Individuals who do not meet the age requirements for this course should be
directed to another course that is appropriate for their age range (for example, Junior Lifeguarding).
Please visit redcross.org for additional course information.
■■ If a candidate is not successful on the first attempt at the prerequisite skills, they only have one more
opportunity to meet the prerequisites after sufficient rest, prior to the first scheduled class session.
■■ If the candidate does not successfully perform any of the prerequisite skills, suggest appropriate
developmental training opportunities and explain the specific skills that the individual needs to
improve to be eligible to participate in the Lifeguarding course in the future.

Program Prerequisite Skills
Swimming Treading Water Timed Event
Lifeguarding Swim 300 yards, Tread water for Complete a timed event within 1
and continuously 2 minutes, using minute and 40 seconds:
Waterpark demonstrating breath only the legs. ■■ Starting in the water, swim 20
Skills control and rhythmic Candidates should yards. Swim goggles are not
Module breathing. Candidates place their hands allowed.
may swim using the front under their armpits. ■■ Surface dive, feet-first or head-
crawl, breaststroke or a first, to a depth of 7 to 10 feet to
combination of both, but retrieve a 10-pound object.
swimming on the back or ■■ Return to the surface and swim
side is not allowed. Swim 20 yards on the back to return to
goggles may be used. the starting point with both hands
holding the object and keeping
the face at or near the surface to
breathe (or to get a breath).
■■ Exit the water without using a
ladder or steps.
Shallow Swim 100 yards Tread water for Complete a timed event within 50
Water continuously 2 minutes, using seconds.
Lifeguarding demonstrating breath only the legs. ■■ Starting in the water, swim 20
control and rhythmic Candidates should yards using the front crawl or
breathing. Candidates place their hands breaststroke. The face may be in
or out of the water. Swim goggles
may swim using the front under their armpits.
are not allowed.
crawl, breaststroke or a
■■ Submerge to a depth of 4 to 5
combination of both but feet to retrieve a 10-pound object.
swimming on the back or Return to the surface and walk
side is not allowed. Swim or swim 20 yards to return to the
goggles may be used. starting point with both hands
holding the object at the surface
of the water.
■■ Exit the water without using a
ladder or steps.

Program Prerequisite Skills, Continued
Swimming Treading Water Timed Event
Waterfront ■■ Swim 550 yards, Tread water for Complete a timed event within 1
Lifeguarding continuously 2 minutes, using minute and 40 seconds.
demonstrating only the legs. ■■ Starting in the water, swim 20
breath control and Candidates should yards. The face may be in or out
rhythmic breathing. of the water. Swim goggles are
place their hands
Candidates may swim not allowed.
under their armpits.
using the front crawl, ■■ Surface dive, feet-first or
breaststroke or a headfirst, to a depth of 7 to 10
combination of both, feet to retrieve a 10-pound object.
but swimming on the ■■ Return to the surface and swim
back or side is not 20 yards on the back to return to
allowed. Swim goggles the starting point with both hands
may be used. holding the object and keeping
the face at or near the surface
■■ Additional in order to breathe (or to get a
Prerequisite: breath).
Swim 5 yards,
submerge and retrieve
three dive rings placed
5 yards apart in 4 to 7
feet of water, resurface
and continue to swim
another 5 yards to
complete the skill
sequence.
Aquatic Complete the water n/a Complete a timed event within 50

Attraction competency sequence seconds without stopping.
Lifeguarding without stopping. ■■ Starting in the water, walk or swim
■■ Step into water from 20 yards.
the side and totally ■■ Submerge to a depth of 3 feet to
submerge. retrieve a 10-pound object.
■■ Maintain position for ■■ Return to the surface and walk
1 minute by treading or swim 20 yards on the back to
water or floating (or return to the starting point with
a combination of the both hands holding the object at
two). the surface of the water.
■■ Exit the water without using steps
■■ Rotate one full turn and
orient to the exit. or a ladder.
■■ Level off and swim on
the front or back 25
yards.
■■ Exit without using a
ladder or steps.

■■ Current certification or a certification expired by no more than 30 days for the course being reviewed
is a requirement for participation in the following review courses:
cc Lifeguarding review course
cc Aquatic Attraction Lifeguarding review course
cc Shallow Water Lifeguarding review course
cc Waterfront Skills review course
cc Waterpark Skills review course
PROGRAM COURSES AND MODULES

■■ The Lifeguarding core course includes Lifeguarding or Shallow Water Lifeguarding or Aquatic
Attraction Lifeguarding and First Aid/CPR/AED. The following modules can be added to form a
course. Lifeguarding add-on module courses may be combined with the core lifeguarding course.
cc Waterfront Skills module
cc Waterpark Skills module
■■ Waterpark Skills may also be combined with the Shallow Water Lifeguarding course.
The following optional modules can be taught separately or added to any course and do not require
participants to gain a Lifeguarding certification:
■■ Asthma Inhaler Training
■■ Epinephrine Auto-Injector Training
■■ Tourniquet Application Training
■■ Bloodborne Pathogens Training
■■ Administering Emergency Oxygen
PROGRAM DELIVERY METHODS

There are two delivery methods available for the courses in the American Red Cross Lifeguarding
program—classroom and blended learning. The blended learning option combines online learning with
in-person skill sessions conducted by a Red Cross-certified instructor. Participants in blended learning
courses acquire the same knowledge and skills as those in traditional classroom training courses.
PROGRAM INSTRUCTIONAL DESIGN
Blended Learning Course Design
The lesson plans employ a variety of methods to meet participants’ needs for consistent, high-quality
instruction and accurate information. To help participants acquire new information, build correct
psychomotor skills, and develop decision-making and problem-solving skills, a variety of interactive
activities are integrated into the lessons along with videos and skill demonstrations, skill sessions,
traditional lectures and guided discussions.
The lecture points included in the lesson plans represent the fundamental concepts and specific
content that instructors must communicate for participants to meet the associated learning objectives
and successfully complete the skill sessions. The lecture points are written so they can be read aloud.
The instructor can also rephrase the lecture points to fit their natural speaking style. The course
presentation (similar to a PowerPoint presentation) includes the lecture points and visual aids to
support participants’ acquisition of the material.

Guided discussions and activities are designed to correspond with the lesson objectives and reinforce
essential information that participants need to know. Guided discussions and activities allow the
instructor the opportunity to assess participants’ understanding of the material. The activities are to
be conducted as designed and may not be changed or omitted. However, modifications can be made
to accommodate participants with disabilities. For more information, see the American Red Cross
Inclusion Resource Guide, located in the Resources section of the Red Cross Learning Center.
Video segments are shown both in the eLearning modules and in-person skill sessions and are designed
to enliven the program by conveying key concepts and providing uniformly consistent explanations and
demonstrations of skills. During the skill sessions, participants may use skill sheets (available in the
participant’s manual) as a guide. Skill charts and skill assessment tools for the instructor’s use during the
skill sessions are located in the instructor’s manual at the end of all lessons that include skill sessions.
Aquatics courses include in-water skill sessions. Teaching progressions are used to provide the
opportunity for participants to practice and gain experience in the water performing swimming and water
rescue skills. The lifeguarding courses include:
■■ Skill sessions to learn new skills by guided practice and corrective feedback.
■■ Skill drills to allow practice of these newly learned skills. The drills are used to help reinforce the skills
learned up to that point. Repetition is important as participants learn throughout the course.
■■ Putting It All Together activities and scenarios are used to apply information and skills learned by
combining skills with critical thinking, decision-making and problem-solving in various situations. In
order to successfully complete the course, participants must complete the final skills scenarios.
■■ Team (multiple-rescuer) skill practice focuses on team dynamics and communication emphasizing
team coordination and management.
Skills can be quickly forgotten. The more participants have the opportunity to practice, the better their
skill performance and retention will be.
When following the extended outline of the Blended Learning Lifeguarding course, homework is
assigned between sessions. Examples include:
■■ Online assignments
■■ End of chapter review questions
■■ Reading assignments
Instructor’s Note: For reasons of educational quality and participant safety, the following
skills taught in many American Red Cross courses are practiced only on a manikin and
never on a real person: ventilations, chest compressions and AED pad placement.
Participants demonstrate competency throughout the courses in the Lifeguarding program by actively
participating in activities, guided discussions, skill sessions, skill drills and Putting It All Together
scenarios that conclude most lessons in the program. In the courses that comprise the Lifeguarding
program, written exams are required.

PROGRAM MATERIALS
Participant Resources
The Lifeguarding Manual has been designed to simplify learning and understanding of the material. The
manual reinforces key points from the lecture portions of the course and contains skill sheets. It serves
as an in-class tool and as a reference tool after the course is completed.
All participant resources are available for purchase at the Red Cross Store; the store is accessible via a
link provided in the Red Cross Learning Center.
Digital course manuals are available for download upon launching the class. Go to the Red Cross
Learning Center—Instructor Portal.
American Red Cross Lifeguarding Manual

The Lifeguarding Manual has been designed to simplify learning and understanding of the material. The
manual reinforces key points from the lecture portions of the course and contains skill sheets. It serves
as the required in-class text and is used as a reference tool after the course is complete. Participants
should have access to their own manual throughout the course in either digital or print format. When
using a digital manual, a tablet or laptop should be used to ensure proper viewing (the manual should
not be displayed on a cell phone.)
Online Content for Lifeguarding Blended Learning Course

In the blended learning courses, the online component has been designed to instruct participants in the
knowledge-based aspects of the Lifeguarding program, as well as to introduce them to the skills they
will practice and master during the instructor-led portion of the training. Instructors should conduct brief,
guided discussions on key online learning topics to ensure participants’ questions are answered.
Instructor Resources
American Red Cross Lifeguarding Blended Learning Instructor’s
Manual
The Blended Learning Lifeguarding Instructor’s Manual is available exclusively in digital format on the
Red Cross Learning Center.
■■ Section A: Program Administration contains information needed to conduct the course and
provides a course overview, explains how to set up and teach the course, gives requirements for
successful course completion and describes what to do when the course is completed.
■■ Section B: The Blended Learning Lifeguarding and Shallow Water Lifeguarding courses
include the course outlines and the lesson plans to teach the Blended Learning Lifeguarding and
Shallow Water Lifeguarding courses. The lesson plans provide the instructor with the primary points
to be covered in each lesson and with guidelines for classroom activities.
cc When following the intensive outline, participants are expected to complete all eLearning modules
before attending the first in-person skill session.
cc When following the extended outline, at the end of each in-person session, remind participants
to read the necessary chapters in the Lifeguarding Manual and to complete the required lessons
in the Lifeguarding Blended eLearning component. These homework assignments must be
completed before attending the facility-based sessions covering the same topics.
cc Before attending the in-person skill session, instructors should monitor the course completion
status of each participant in the Red Cross Learning Center. The instructor can send out a
reminder to any participants that they must complete the online content prior to the class.

cc Two outlines are available in Section B to teach the Blended Learning Lifeguarding course:
●● The Intensive Outline is recommended for intensive class sessions held back-to-back,
such as a long weekend class. The intensive outline is designed to allow participants to
complete all eLearning content prior to the first in-person sessions. It is recommended that
instructors who wish to follow the intensive outline conduct the precourse skills session
before participants take the eLearning content. When following the intensive outline,
instructors should check participant progress reports before beginning Lesson 1 to ensure
that participants have completed all required eLearning content. Participants are required to
complete all eLearning content prior to the first in-person session of the course. Participants
must be given sufficient time to complete the approximately 7 hours of eLearning content.
●● The Extended Outline is recommended for classes held over a longer period of time
(e.g., alternating days, several weeks or a semester). The extended outline is designed
to allow participants to alternate between eLearning and classroom sessions with
days or weeks between. When following the extended outline, instructors will check
participant progress reports at the beginning of each lesson and assign eLearning
content and reading as homework assignments at the end of each lesson.
■■ Section C: Appendices includes supplemental materials to support the courses in the Lifeguarding
program, including the Final Written Exams, Answer Sheets and Answer Keys.
cc The CPR/AED for Professional Rescuers and First Aid final written exam is taken online for
the blended learning Lifeguarding and Shallow Water Lifeguarding courses. It is located in the
conclusion module and must be successfully passed before the participant attends the final facility
session. This must be confirmed by the participants’ completion record. If the conclusion lesson is
complete, the participant successfully passed the CPR/AED for Professional Rescuers and First
Aid exam.
Video Segments
The video segments are an integral part of the course. Instructors are required to use the video
segments where indicated in the Blended Learning Lifeguarding Instructor’s Manual because they
contain important information about key concepts and skills to help ensure the course objectives are
met. Participants view most of the lifeguarding video segments in the eLearning section of the blended
learning course. See Appendix D for a complete list of video segments included in this course. The
courses in the Lifeguarding program cannot be conducted if the video segments are not available.
They are included on the Lifeguarding program DVD, which is available for purchase on the Red Cross
Store. The video segments are also available for streaming from the Red Cross Learning Center and
embedded in the course presentations.
Course Presentations
The following course presentations to support the Lifeguarding program are available:
■■ Lifeguarding course presentation (for use with the Lifeguarding and Shallow Water Lifeguarding
course)
■■ Lifeguarding course presentation for Blended Learning
■■ Aquatic Attraction Lifeguarding
■■ Waterfront Lifeguarding
■■ Waterpark Lifeguarding
■■ CPR/AED for Professional Rescuers (for the stand-alone CPRO course)

Similar to a PowerPoint presentation, each course presentation is an in-class visual aid that is projected
onto a screen or viewing area. Instructors click through the presentation slides as they progress through
the lessons.
The course presentations include lecture points, imagery and the required course video segments. To
assist in teaching, slide references are included in the lesson plan along with the course presentation.
The course presentation:
■■ Provides visual reinforcement of key points made during lectures and guided discussions.
■■ Provides visual aids that support activities and scenarios.
■■ Provides an alternate method of showing the video segments that support the course.
■■ Helps you deliver information in a more dynamic way by reducing dependence on the instructor’s
manual and allowing you the freedom to stand up and move around during the lesson.
Before conducting the course, become familiar with the presentation software and test the display of the
system to be used. It is recommended that you have backup copies of the presentation in case technical
difficulties occur.
The course presentations are available to download from the Red Cross Learning Center. The
presentation is saved in PDF format. To view the presentation, save the file to your computer and
double-click on the PDF icon to open it. Additional directions for using the course presentation are
available on the Red Cross Learning Center. For online viewing (i.e., streaming from the Red Cross
Learning Center) a high-speed Internet connection is required.
The course presentations that support the Lifeguarding program are also available on the Lifeguarding
program DVD, which is available for purchase on the Red Cross Store.
THE RED CROSS LEARNING CENTER

The Red Cross Learning Center (redcrosslearningcenter.org) provides functionality for American
Red Cross Training Services users to administer, track, report and deliver training as well as maintain
certification data. The Red Cross Learning Center includes all the content used by students, instructors
and training provider partner administrators in one place. Users will be able to access different
resources and functionality based on user profile roles (as a student, as an instructor or as a partner
administrator).
Students
Students (non-instructors) taking online only or blended learning courses will use the Red Cross
Learning Center—Student Portal to:
■■ Access and launch online courses.
■■ Access relevant digital course materials.
■■ View their certifications.
■■ Link to the Red Cross Store to purchase course materials and supplies.
■■ Learn more about the science behind the course content.
■■ Learn about other opportunities, such as becoming an instructor.
■■ Get help from the Training Support Center.
Instructors
Red Cross instructors must be affiliated with an organization with a Red Cross Training Provider
Agreement, or be a Red Cross Training Services employee or volunteer, to access the password-
protected instructor portal view of the Red Cross Learning Center.

As a Red Cross instructor, you will use the Red Cross Learning Center—Instructor Portal to:
■■ Access and launch any online or blended courses you are taking.
■■ Access all instructor resources for teaching and administering courses such as:
cc Program and course materials – digital versions of participant manuals, instructor manuals, written
final exams and instructor bulletins.
cc Teaching resources – streaming video segments and course presentations.
cc How-to information and videos.
cc About the Science sections, including expert answers to technical questions and research topics.
■■ Manage classes you are teaching by being able to:
cc Set up blended learning classes in advance.
cc Monitor student online course completion status.
cc Report and close out courses.
cc Provide digital certificates to students immediately.
■■ View class history details on all the courses you have taught.
■■ Manage your instructor certifications, with the ability to:
cc View your certifications.
cc Launch online instructor recertification and program update courses.
cc Learn about bridging to become an instructor in other program areas or becoming an instructor
trainer.
■■ Stay abreast of the latest information.
cc Network with other instructors through the forum.
cc Read the latest news and iConnection newsletter from the Red Cross.
Partner Administrators
Training provider organizations can designate one or more individuals to the role of “partner
administrator” to allow them to manage Red Cross-certified instructors affiliated with their organization.
The partner view provides access to all resources and functions of the instructor view, plus additional
functionality to manage instructors. The administrator role does not require an instructor certification.
Partner administrators use the Red Cross Learning Center—Partner Portal to:
■■ Manage Instructors.
cc Request to affiliate (add) and unaffiliate (remove) certified instructors to their organizations’ Red
Cross Training Provider Agreement.
cc View instructor list and reports on certification and expiration dates.
■■ Manage classes.
cc Utilize the Class Posting Service to list classes being offered by the partner on the Red Cross
website.
cc Set up blended learning classes and assign instructors.
cc View online course completion status for all blended learning classes.
cc Close out and report classes on behalf of instructors.
cc View class history details for all classes.

CHAPTER 2
BECOMING AN AMERICAN RED CROSS
INSTRUCTOR
INSTRUCTOR REQUIREMENTS
Eligibility to Teach the Courses in the Lifeguarding Program
Lifeguarding instructors are eligible to teach the following Red Cross Lifeguarding courses and
modules:
■■ Lifeguarding course
■■ Shallow Water Lifeguarding course
■■ Aquatic Attraction Lifeguarding course
■■ Waterpark Skills module
■■ Waterfront Skills module*
■■ CPR/AED for Professional Rescuers
■■ Basic Water Rescue
■■ Safety Training for Swim Coaches (after completing online orientation)
■■ Review courses (for the courses listed above)
■■ Water safety presentations
■■ Longfellow’s WHALE Tales
■■ Junior Lifeguarding
■■ Asthma Inhaler Training
■■ Epinephrine Auto-Injector Training
■■ Tourniquet Application Training
■■ Bloodborne Pathogens Training
■■ Administering Emergency Oxygen (Lifeguarding instructors trained after January 3, 2017, are
required to have a basic-level certification to teach this module)
*To become a Waterfront Lifeguarding instructor, current basic-level certification in the Waterfront Skills
module is required. However, an instructor or instructor trainer is not required to maintain a Waterfront
Skills basic-level certificate in order to maintain the instructor-level certificate.
Maintaining Your Instructor Certification © 2011, 2017, 2019 The American National Red Cross. All rights reserved.
Your certification as an instructor is valid for 2 years. To maintain certification as an instructor, you must:
■■ Teach or co-teach at least one of the following core courses of record during your 2-year certification
period:
cc Lifeguarding
cc Shallow Water Lifeguarding
cc Aquatic Attraction Lifeguarding
■■ Successfully complete the Lifeguarding Instructor/Instructor Trainer Review course prior to your
instructor certification expiration date.
cc Participation in the Lifeguarding Instructor/Instructor Trainer Review course meets basic-level
skill competency requirements, but not basic-level certification. Instructors will have the option
to achieve basic-level certification to work as a lifeguard at the conclusion of the Lifeguarding
Instructor/Instructor Trainer Review course.
■■ Complete all applicable course updates prior to the update deadline.

Instructor’s Note: As an instructor, you have a responsibility to monitor and maintain
your Red Cross Learning Center profile. You must periodically verify that your contact
information is accurate in the Red Cross Learning Center, including a current email
address, phone number and mailing address. The Red Cross Learning Center will
automatically track the expiration date of your instructor certification. Monitoring your
profile and certifications within the system allows you to take appropriate actions to stay
current in your certification.
Eligibility to Teach Other American Red Cross Programs

American Red Cross Lifeguarding instructors may qualify to teach additional Red Cross basic-level
courses after successful completion of an instructor bridge course.
Available instructor bridge course options (depending on program):

1. Online bridge course
2. In-person or blended learning bridge course
Additional basic-level certifications may be necessary in addition to completing an instructor bridge

course. The Instructor Bulletin for the specific program area lists the bridging options available as well
as qualification requirements. Please check the specific program area of the Red Cross Learning Center
for more information on any requirements needed to complete an instructor bridge.
INSTRUCTOR RESPONSIBILITIES
Your responsibilities as a certified Red Cross instructor include:
■■ Providing for the health and safety of participants by always ensuring:
cc Manikins have been properly cleaned according to “Recommendations on Manikin
Decontamination,” which is available on the Red Cross Learning Center.
cc Course equipment is clean and in good working order.
cc Participants are aware of health precautions and guidelines concerning the transmission of
infectious diseases.
cc All participants have the physical ability to perform the skills and know they can consult you if they
have concerns about their physical ability to do so.
cc The classroom, aquatic facility and all practice areas are free of hazards.
■■ Being familiar with and knowing how to effectively use program materials and training equipment.
■■ Informing participants about knowledge and skills evaluation procedures and course completion
requirements.
■■ Creating a non-threatening environment that is conducive to achieving the learning objectives.
■■ Preparing participants to meet the course objectives.
■■ Conducting the precourse session to determine if participants have the prerequisite knowledge and
skills to take the course.
■■ Providing participants an opportunity to evaluate the course.
■■ Adapting your teaching approach to match the experience and abilities of the participants, identifying
participants who are having difficulty and developing effective strategies to help them meet course
objectives.
■■ Supervising participants while they are practicing course skills and providing timely, positive and
corrective feedback as they learn.
■■ Evaluating participants as they perform skills, focusing on critical performance steps as described in
the skill charts.
■■ Being prepared to answer participants’ questions or knowing where to find the answers.
■■ Administering and scoring the final written exams.
■■ Conducting courses in a manner consistent with course design.
■■ Teaching courses as designed—following all course outlines, policies and procedures as noted in the
instructor course documents.

■■ Maintaining a current personal profile in the Red Cross Learning Center.
■■ You must close the course in the Red Cross Learning Center within the specified time frame (10
days).
■■ Being familiar with and informing participants of other Red Cross courses and programs.
■■ Representing the Red Cross in a positive manner and providing a positive example by being neat in
appearance and not practicing unhealthy behaviors while conducting American Red Cross courses.
■■ Abiding by the obligations in the Instructor Handbook, Instructor Agreement and Code of Conduct
and, if applicable, the Red Cross Training Provider Agreement.
■■ Promoting volunteer opportunities available through the Red Cross.
MAINTAINING CONSISTENT TRAINING STANDARDS

Quality, consistency and standardized delivery of courses are priorities of the American Red Cross.
Red Cross courses are designed with standardized instructor outlines and lesson plans based on
well-defined objectives to provide an optimal learning experience for the variety of participants who
participate in the programs. To meet the objectives of the course and ensure standardized course
delivery, the course outline and lesson plans must be followed.
Facility availability or constraints, specific instructor-to-participant ratios, equipment-to-participant

ratios or participant needs may necessitate adapting the outline while still maintaining the educational
progression of the course. Adapting the training does not mean that you can add to, delete or change
the content. The course is laid out in a progressive way to allow the participants to learn in a predictable
order as well as have sufficient time to practice.
Courses in the Lifeguarding program are designed to meet the training requirements of various aquatic
facility settings, including pools, waterparks and waterfronts. Both the course participants and the
organizations that hire lifeguards expect and depend on the quality training as outlined in the program.
The following course outlines in Section B are included to use when teaching the course. These outlines
allow instructors to adapt the course schedule to meet their organizational and scheduling needs
without sacrificing course content:
■■ Intensive Outline—All eLearning content must be completed prior to the first in-person skill session.
■■ Intensive Format—Participants must complete the assigned eLearning module(s) prior to attending
the corresponding in-person skills session. eLearning content is assigned as “homework” after each
in-person skill session.

CHAPTER 3
SETTING UP AND RUNNING COURSES
SETTING UP AND CLOSING OUT A BLENDED LEARNING

COURSE
All blended learning courses must be set up in the Red Cross Learning Center and include an online
portion to be completed by the participant prior to the first class meeting. All courses should be set
up at least 2 weeks prior to the first in-person session. This is to allow participants time to receive
registration information and complete the required online content before attending the first in-person
session.
The instructor can view the online completion status for each participant in the Classes I’m Teaching
section of the Red Cross Learning Center. The instructor can send out a reminder to any participant that
they must complete the online content prior to the class.
Once the blended course is set up and participants are enrolled, they will have immediate access to
the online course and digital course materials in the Red Cross Learning Center. Once the instructor
closes the course in the system, a system-generated email will send the certificate. For details on how
to request to set up and close out a blended learning class, refer to the Resources section of the Red
Cross Learning Center.
COURSE LENGTHS AND SCHEDULES

Classroom
The course outlines (see Section B) include course lengths. The times allotted in the course outlines
include the minimum time required for covering the content and class activities and do not include breaks.

Lessons In-Person Time eLearning Time eLearning Modules to be
completed before attending
In-Person Skill Session
Precourse 1 hr n/a n/a
1 15 minutes 20 minutes • Introduction
• The Professional Lifeguard
2 45 minutes 2 hours, 10 • Facility Safety and Patron Surveillance
minutes
3 1 hour, 15 minutes 40 minutes • Injury Prevention
4 4 hours, 10 minutes 1 hour • Water Rescue Skills
5 1 hour, 40 minutes 40 minutes • Before Providing Care and Breathing
Emergencies
6 3 hours, 15 minutes 45 minutes • Cardiac Emergencies and Using an
AED
7 2 hours, 5 minutes 55 minutes • First Aid
8 2 hours, 25 minutes 30 minutes • Head, Neck and Spinal Injuries
9 3 hours, 5 minutes Varies • Conclusion (includes CPR/AED for
Professional Rescuers and First Aid
final written exam)
Total 19 hours, 55 minutes 7 hours
Course lengths are based on:

■■ A ratio of 10 participants to 1 instructor
■■ A minimum of 1 manikin and 1 AED training device for every 2 participants
■■ A minimum of 1 rescue tube for every 2 participants
■■ A minimum of 1 backboard for every 3 participants
Increasing one or more of these ratios may increase the pace of the skills practice sections of the
course but will not reduce overall course time significantly. Therefore, courses are to be scheduled and
expected to run for the designated course length, at a minimum.
The lesson plans in this manual must be followed as closely as possible, but facility constraints, specific
instructor-to-participant ratios, equipment-to-participant ratios and participant needs (e.g., breaks) may
increase course length. Other factors that may influence lesson planning include the following:
■■ Classroom availability and layout
■■ Pool availability and layout (depth, activities, lifeguard availability, etc.)
■■ Equipment availability
■■ Number of participants
■■ Skill level of participants
■■ Number of instructors

CLASS SIZE AND INSTRUCTOR-TO-PARTICIPANT RATIOS
The courses in the Lifeguarding blended program are designed for a ratio of 10 participants to one
instructor. If your class is larger, you may not be able to properly supervise the course activities and skill
sessions in the allotted time. Likewise, if there is fewer than the minimum number of participants, you
may not be able to conduct course activities and skill sessions properly to meet course objectives.
If there are fewer than five participants, additional people certified in the program specialty area
(lifeguarding/first aid/CPR/AED) must be added throughout the course to achieve the course objectives
through practicing skills, scenarios, testing and other course activities. The instructor cannot act in the
role of the assisting responder or victim in the skill practices and scenarios. At no time should a single
instructor teach a course with fewer than five qualified participants.
If the course has more than 10 participants, another instructor should co-teach and the course may
need to be extended. At no time should a single instructor attempt to manage a course with more than
10 participants.
CLASSROOM SPACE
The courses in the Lifeguarding Blended Learning program require a classroom space suitable for
lecture, small group activities, role-playing activities, video presentations and skill sessions. The
classroom should provide a safe, comfortable and appropriate learning environment. The room should
be well lit, be well ventilated and have a comfortable temperature.
Instructor’s Note: If the area where skill sessions will be conducted is not carpeted,
provide knee protection (such as folded blankets or mats) for use by participants or
request that they bring their own padding materials.
SWIMMING AREA
A pool is recommended for skill practice, practice teaching and skill evaluations. The pool must meet the
requirements needed to conduct the following:
■■ A 300-yard swim that continuously demonstrates breath control and rhythmic breathing. Candidates
may swim using the front crawl, breaststroke or a combination of both, but swimming on the back or
side is not allowed. Swim goggles may be used.
■■ Treading water using only the legs for 2 minutes.
■■ A timed event performed within 1 minute, 40 seconds. Starting in the water, swim 20 yards. The face
may be in or out of the water. Swim goggles are not allowed. Surface dive, feet-first or head-first, to
a depth of 7 to 10 feet to retrieve a 10-pound object. Return to the surface and swim 20 yards on
the back to return to the starting point, with both hands holding the object and keeping the face at or
near the surface in order to breathe (or get a breath). Candidates should not swim the distance under
water. Exit the water without using a ladder or steps.
■■ A submerged victim rescue.
■■ A demonstration of how to care for a head, neck or spinal injury in deep water.
If a waterfront or waterpark facility is used, select a swimming area that has no surf, is free from
obstructions, and has sufficient space and depth for skills practice, in-water activities, practice teaching
and skills evaluations.

To ensure consistency in course delivery, facilities must be used that meet the guidelines for conducting
the course activities. More than one facility can be used to accommodate the lesson plan activities.
An adequate number of certified lifeguards, sufficient to respond to an emergency per the facility
emergency action plan, must be on duty during all in-water sessions. Lifeguard(s) with no duties
beyond those of patron/participant surveillance must be present during all in-water activities. Course
participants and/or instructor(s) may NOT act as the lifeguard on duty.
ADDITIONAL MATERIALS, EQUIPMENT AND SUPPLIES

The specific materials, equipment and supplies needed for each lesson are included at the beginning of
the lesson. Instructors should have the specific equipment needed for the lesson ready prior to the start
of the lesson. Supplies that instructors should have available include the following:
Equipment:
■■ CPR manikins
cc Adult and infant manikin (one for every two participants)
cc Child manikin (optional; one for every two participants)
■■ Resuscitation masks
cc Adult and pediatric pocket masks with a compatible one-way valve OR a combination mask (one
for the instructor and one for each participant)
■■ Bag-valve-mask (BVM resuscitators)
cc Adult BVM (one for each adult manikin)
cc Infant BVM (one for each infant manikin)
cc Child BVM (optional; one for each child manikin)
■■ AED Training Devices with adult and pediatric AED pads (one for each set of adult and infant
manikins)
■■ Rescue tubes (one for every two participants)
■■ Backboards with at least one strap and head immobilizer (one for every three participants).
■■ Timing device, such as a stopwatch or smartphone with a stopwatch feature (one per instructor)
■■ 10-pound object (a diving brick or weight—one for every five participants)
Supplies:
■■ Latex-free nitrile gloves
■■ Hip packs (one for each participant)
■■ Manikin decontamination supplies (decontaminating solution, 4’’ × 4’’ gauze pads, soap and water,
brush, basins or buckets, latex-free nitrile gloves and any accessories that may be recommended by
the manufacturer of the manikin)
■■ Blankets and/or mats (optional)
■■ Name tags (optional; one for each participant)
■■ Pens, pencils (one for each participant)
Technology:
■■ Desktop/laptop computer or tablet with power source and speakers, projector and projection screen/
area or large monitor, OR
■■ Television with a DVD player (optional)
■■ Extension cord and grounded plug adapter, if needed
Course Materials:
■■ Lifeguarding Instructor’s Manual
■■ Lifeguarding DVD set or Lifeguarding course presentation
■■ Lifeguarding Manual
■■ American Red Cross instructor identification

■■ Participant Skill Sheets (in each participant’s Lifeguarding Manual)
■■ Final Written Exams A and B (one for each participant; available on the Red Cross Learning Center)
■■ Final Written Exam Answer Sheets (two for each participant; see Appendix G)
■■ Extra copies of Final Written Exam (Exams A and B) and Answer Sheets
■■ Skill Charts and Skill Assessment Tools (at the end of each lesson in the instructor’s manual)
■■ Participant Progress Log (see Appendix F)
Waterfront Skills—Additional Materials, Equipments and Supplies:

In addition to the equipment, materials and supplies listed above, additional supplies are required for the
Waterfront Skills course:
■■ Rescue board
■■ Three diving rings
■■ Mask, assorted sizes (one per participant)
■■ Fins, assorted sizes (one pair per participant)
■■ Waterfront course presentation or Lifeguarding course DVD
■■ Course-specific materials (written exams, answer sheets, answer keys)
Instructor’s Note: Equipment used during the course, including American Red Cross hip
packs and a wide range of Red Cross retail products, is available on the Red Cross Store
(redcrossstore.org). Hip packs are available with resuscitation masks, gloves and a whistle.
CLASS SAFETY AND SUPERVISION

As a Red Cross instructor, it is important for you to make the teaching environment as safe as possible
and to protect participants from health risks. The materials and procedures for teaching American Red
Cross courses are designed to:
■■ Limit the risk of disease transmission.
■■ Limit the risk of one participant injuring another when practicing skills with a partner.
■■ Limit the risk that the activity involved in skill practice could cause injury or illness. Establish a “safe
signal” for participants to communicate when practicing underwater skills or skills with physical
contact (e.g., a pinch or tap indicating the rescue should be immediately stopped and participants
should return to the surface).
Participants who feel they are at risk for injury or illness may become distracted. These same feelings
may also affect your ability to teach. It is important to talk with participants who feel they are at risk and
inform them of the precautions that are taken to limit and reduce the risk for injury or illness. There are
several steps you can take to help increase class safety:
■■ Prepare. Consider possible hazards and manage safety concerns before a course starts. Often, you
can foresee hazards and take steps to eliminate or control them long before participants arrive.
■■ Arrange for assisting instructors, co-instructors or both. Assisting instructors and
co-instructors can help decrease risks by giving more supervision and reducing the instructor-
to-participant ratio. They also increase participation and learning by providing more one-on-one
attention to participants. When using assisting instructors or co-instructors, clearly define their roles
and responsibilities. Doing so will help eliminate confusion and lapses in supervision. Remember that
you are ultimately responsible for your participants’ safety. To determine your staffing needs, consider
the different ages and the individual abilities of participants. If your course has a large number of
participants, you will need additional help.

Health Precautions for Course Participants and
Considerations for Participants with Disabilities
Provide participants and, if necessary, their parents or guardians information about health requirements
and safety before the course begins.
People with physical disabilities or certain health conditions may hesitate to take part in skill sessions.
You should suggest that these participants (or, if the participant is a minor, the participant’s parent or
guardian) discuss their participation with a healthcare provider. Ask participants to tell you in advance if
they are concerned about their ability to perform a specific skill.
Inform participants who cannot demonstrate the skills required for certification for the course that they
would not receive a Red Cross course certificate. Encourage them to participate to the extent possible.
The Red Cross advocates that instructors adjust activity levels to facilitate learning and to help meet
course objectives when possible.
Guidance for course modification for a participant with a disability is provided in the American Red
Cross Inclusion Resource Guide, located in the Resources section of the Red Cross Learning Center.
Additional Adult Supervision—Teaching Youth

The safety of all Red Cross course participants is paramount. For courses with participants younger
than 18 years, ensuring participant safety includes providing adequate adult supervision. (Some states
may define an adult as a person older or younger than 18 years. Follow local regulations.)
It is recommended that whenever a Red Cross course, activity or event is conducted involving youth
participants, two adults should always be present at the facility to ensure participant safety. For Red
Cross courses, the first adult would be the course instructor. The second adult might be a co-instructor,
another participant or—in the event that the course audience is entirely comprised of youth—an
instructor teaching another course in the facility or other responsible facility staff. Facilities should
consider safety plans for youth participants that include the time before and after class.

CHAPTER 4
TEACHING SO THAT EVERY PARTICIPANT CAN
LEARN
PREPARING TO TEACH
Before you teach a lesson, you should read the lesson plan; review appropriate reference materials
(such as skill sheets, skill assessment tools, eLearning content and the participant’s manual); and gather
necessary materials, equipment and supplies. The lesson plan contains the following:
■■ Lesson name
■■ Lesson length (the estimated amount of time needed to conduct the lesson)
■■ Guidance for the Instructor (objectives the instructor must meet in order to complete the lesson and
meet the course requirements)
■■ Lesson Objectives (statements describing what participants will know or be able to do after
successfully completing the lesson)
■■ Additional Materials, Equipment and Supplies (a list of the materials, equipment and supplies needed
to teach the lesson)
■■ Session Preparation (tips on how to prepare for the lesson)
■■ Teaching Tips (teaching tips to remember)
■■ Topics (the major concepts to be covered in the lesson)
■■ Instructor’s Notes (instructions and information related to conducting the lesson effectively)
■■ About the Science Notes (more in-depth information about the scientific basis for the information and
skills taught in the lesson)
■■ Lesson Wrap-Up (assignments and end of chapter questions to provide participants with the
opportunity to review what they have learned)
WORKING WITH YOUR AUDIENCE

Understanding your audience will help you engage your participants. If you can relate to your audience,
you will be better able to provide a positive learning environment and maintain participants’ self-
esteem. In addition, understanding your audience allows you to help participants associate classroom
information with personal experiences, which in turn can make guided discussions and activities more
meaningful. Being aware that participants may come to the class with different levels of understanding
and skill can help you better meet each participant’s needs.

USING FACILITATION TECHNIQUES
As an instructor, you will use facilitation techniques to help participants acquire necessary information.
Facilitation is based on the concept of pushing, pulling and balancing the flow of information. Push
skills have to do with information flowing mostly from instructor to participants. Pull skills are used
when the instructor engages participants using approaches that actively involve the participants in their
own learning, such as by asking questions or facilitating interactive activities and guided discussions.
Balance skills involve managing the push and pull of information to keep the learning process moving
and to maximize learning.
When using facilitation techniques, keep in mind the following points:

■■ Maximize class interaction.
■■ Use pull skills to engage participants in classroom discussions and to keep discussions on topic
or to provide necessary information. Pull skills are also useful for soliciting responses from different
participants to prevent one participant from dominating the discussion.
■■ Promote an open exchange of information and ideas by asking open-ended questions (i.e., questions
that begin with “who,” “what,” “when,” “where,” “why” or “how”), waiting for responses, listening,
managing silence and referring participants’ questions back to the group for discussion and
resolution.
■■ Ensure effective discussion sessions by giving and receiving feedback, maintaining an open
perspective, creating a positive environment conducive to learning, staying on topic and managing
time effectively.
Facilitation techniques allow you to evaluate participants’ knowledge and understanding throughout the
course. In addition, facilitation:
■■ Gives you the opportunity to evaluate participants’ needs and focus the activities on those needs.
■■ Allows you to build on participants’ previous knowledge and skills.
■■ Allows participants to associate previous knowledge and skills with new information.
■■ Allows participants to learn from one another.
■■ Keeps participants engaged and interested throughout the course.
TEACHING PARTICIPANTS WITH DISABILITIES

You may have participants in your course who have disabilities or other health conditions. You may
need to increase the amount of time that you spend with the participant or allow frequent rest periods,
if necessary. When a participant with a disability can successfully meet course objectives, they should
receive a course completion certificate. If a participant cannot meet the course objectives because of a
disability, this should be communicated to the participant as early as possible.
Physical Disabilities
When helping a participant with physical disabilities to acquire the skills necessary for successful
course completion, focus on the critical components of the skill that are needed to successfully meet
the objective. Always teach to the standards set forth, but be aware that participants may modify how
a skill is accomplished and still meet the objective, which allows them to successfully complete the
course. See the American Red Cross Inclusion Resource Guide, located in the Resources section of
the Red Cross Learning Center, for more information.

Learning Disabilities
A person who has a learning disability may tell you that they have not done well in educational settings
or testing situations in the past. If you believe that a participant has a learning disability, discuss this with
the participant privately without attracting the attention of the rest of the class.
Many learning disabilities affect a person’s ability to acquire information through reading. Participants
with limited English proficiency may also struggle with reading. You may also observe behaviors that
suggest that a participant has difficulty with reading. For example, you may notice that a participant is
not able to follow along with written material. The participant may offer an excuse, such as saying that
they forgot their glasses. Modifications (such as reading material to participants, rather than having
participants read the material to themselves) will allow the participant to participate fully in class. When
administering the written examination, you may administer an oral exam instead. Please see the Red
Cross Learning Center for guidance on giving oral exams.
STRATEGIES FOR HELPING PARTICIPANTS TO ACQUIRE

INFORMATION
Delivering Information Through Lecture

Instructor presentation, or lecture, is sometimes the most effective way to deliver information.
However, because lecturing is a passive way for participants to learn, it should be used
sparingly. Too much lecturing causes participants to become disengaged, resulting in less
effective learning.
In this instructor’s manual, content that is to be delivered through lecture is designated with the
lecture icon. Lecture points contain information that must be communicated to participants and
are written so that they can be read aloud from this manual. You may rephrase lecture points
to fit your own natural speaking style; however, if you choose to rephrase lecture points in your
own words, it is important that you fully understand the course content so that you can rephrase
without changing the meaning of the lecture point. Participants who are visual learners often
benefit from seeing the lecture points in written form. If you are using the course presentation,
the main points for the lecture are included on the accompanying slide. If you are not using the
course presentation, it is often helpful to write bullet points on a whiteboard or easel pad before
the class to facilitate the learning process.
When delivering a lecture, it is important to be dynamic and engaging. One way to accomplish
this is to prepare for interactive lectures. An interactive lecture will have opportunities for two-
way communication between participants and the instructor as well as among the participants
themselves. To prepare an interactive lecture, keep the following suggestions in mind:
■■ Ensure that you understand the purpose of the lecture and plan accordingly.
■■ Feel free to rephrase the lecture points to fit your natural speaking style.
■■ Prepare lecture notes so that you can avoid reading from the instructor’s manual while
lecturing.
■■ Maintain a learner-centered focus.
■■ Use analogies to help create a bridge between lecture material and participants’
experiences.
■■ Strive for interaction with participants during lectures.
■■ Encourage participants to add to the lecture.
■■ Keep the lecture moving—avoid long stories of personal experiences.

Using Guided Discussion
Guided discussions are another way of conveying and reinforcing course content. In this
instructor’s manual, content that is to be delivered through guided discussion is designated with
the guided discussion icon. Guided discussions serve to:
■■ Monitor and evaluate participants’ level of understanding.
■■ Increase comprehension (i.e., when one or more participants do not understand something,
the discussion may offer an alternative explanation that clarifies the information).
■■ Allow participants to use existing knowledge and experience as a springboard for acquiring
new information.
■■ Focus participants’ attention on the topic.
■■ Ensure that all required content for the topic is covered.
The ability to introduce questions that prompt discussion is an important aspect of facilitating
good discussions. As you lead question-and-answer sessions during the lesson, ask for
volunteers to provide answers. Waiting up to 10 seconds for an answer can help encourage
hesitant participants to answer. Call on participants by name if you are having a hard time
finding volunteers. However, do not insist that all participants provide answers. Participants can
still benefit from this approach to learning, even if they appear reluctant to answer questions
themselves.
Ideal responses are provided for each question. Answers labeled “Responses could include”
are examples of one or more possible correct answers. For these questions, an example of
a correct answer is provided in case participants are unable to come up with the correct
answer(s) on their own. Answers labeled “Responses should include” are the correct answer(s)
that must be covered. In this case, the instructor must provide any or all of the answers if
participants are unable to come up with the correct answer(s) on their own.
Using Video Segments

Video presentations, designated with the icon in this instructor’s manual, are used to
demonstrate skills, convey key concepts or support activities.
Conducting Activities
Activities are included throughout the course to give participants the opportunity to apply
knowledge and solve problems. Many activities allow participants to associate course concepts
with their own personal experience. In this instructor’s manual, activities are designated with the
activity icon.
Activities done as a group promote interaction among participants. Small-group activities

require two to four participants to work together to solve a problem or complete an activity.
Small-group activities allow participants to use one another’s knowledge to solve problems and
learn from others’ experiences. Large-group activities involve a larger group or the entire class.
Large-group activities provide the opportunity to exchange ideas, discuss problems and think
about the many ways to solve a problem.

When conducting group activities, you should specify both the size and makeup of the groups. Form
groups using the fewest number of participants necessary to conduct the activity. Form new groups
for each activity. Changing group members for each activity promotes class cohesion, avoids situations
in which one or more participants feels left out and keeps friendships from taking precedence over
learning. Using an arbitrary selection criterion each time you form groups will help you vary group
makeup and give participants the chance to interact with many different classmates. For example, you
could form groups by asking participants to:
■■ Find the person whose birthday is closest to their own and form a pair.
■■ Find the person who lives the farthest from them and form a pair.
■■ Find the other people in class whose birthdays are in the same season (winter, spring, summer or fall)
as their own and form a group.
Conducting Scenarios
Many activities in American Red Cross courses are scenario-based. Scenario-based activities focus
on developing critical thinking, problem-solving and communication skills and give participants an
opportunity to apply recently acquired knowledge and skills. The scenario typically begins with a
description of the situation and scene, and prompting is used to facilitate participants’ progression
through the scenario. Once the scenario is complete, a debriefing or review session may be held to
reinforce key points, evaluate performance or both.
To conduct scenario-based activities, have participants form groups, distribute any supporting materials
to each group and then communicate the set-up for the scenario used. Participants will then take on
various roles (e.g., lifeguard, victim, additional responder) and work together to complete the scenario.
(Ensure that participants switch roles between scenarios so that every participant has the opportunity to
play each role at least once.) The groups complete the scenario at the same time. During the scenarios,
your focus should be on helping participants apply the knowledge and skills covered in the course to the
simulated emergency situation. Step in and provide guidance only if absolutely necessary.
Although participants are expected to act on the basis of their training, they should be encouraged to
work together and use reference materials (such as skill sheets or the Lifeguarding Manual) as needed.
Because the purpose of the scenario is to simulate responding to a real emergency situation, the
instructor should give prompts according to the scenario. These prompts provide only the information
necessary for the lifeguard and/or assisting responder(s) to make decisions and provide care. If the
lifeguard and/or assisting responder(s) have difficulty determining the correct next step, the instructor
should provide corrective feedback. Because the skills may still be relatively new, it is OK if participants
hesitate, start and stop, self-correct or otherwise momentarily interrupt the skill during scenarios.
To achieve certification, participants must successfully participate in all Putting It All Together scenarios. © 2011, 2017, 2019 The American National Red Cross. All rights reserved.
Successful participation means that a participant went through each scenario (as the lifeguard and
assisting responder) with minimal guidance from the instructor.

CHAPTER 5
CONDUCTING EFFECTIVE SKILL SESSIONS
INSTRUCTOR RESPONSIBILITIES DURING SKILL

SESSIONS
Skill sessions are a critical component of most American Red Cross courses. During the skill sessions,
participants are learning and perfecting skills. For maximum efficiency and the best learning outcomes,
skill sessions should be well organized and well managed. For a successful skill session, instructors
must provide direction and instruction, ample practice time, encouragement and positive reinforcement,
and corrective feedback. During skill sessions, instructors are responsible for:
■■ Demonstrating the skill or skill components and guiding participants through the skill.
■■ Keeping the session running smoothly.
■■ Providing sufficient time for all participants to practice the skill.
■■ Ensuring that participants can see the video monitor when appropriate.
■■ Helping participants form pairs, if necessary, and making sure that participants have the necessary
equipment for skill practice.
■■ Closely supervising participants as they practice.
■■ Identifying errors promptly and providing appropriate feedback to help participants improve.
■■ Checking each participant for skill competency.
■■ Maintaining a safe, positive learning environment.
■■ Encouraging participants to improve and maintain their skills.
■■ Providing global and individual feedback to course participants.
During every skill session, circulate to monitor participants’ progress and provide assistance and
corrective global and individual feedback as necessary.
HOW PARTICIPANTS LEARN SKILLS

When teaching skills, keep the following points in mind:
■■ Course skills are complex. Participants often have some difficulties when they first begin.
■■ The skills taught will likely be new to most participants; therefore, participants may require frequent
one-on-one attention.
■■ Skills are learned by hands-on practice. Immediate success in demonstrating the skill is unlikely.
Refinements in technique take time and practice. Allow participants multiple opportunities to practice
skills.
■■ Skills require a defined sequence of movements. Participants should consistently follow this
sequence when learning skills.
■■ Learning times for each skill differ, because some skills are easier than others.
■■ Participants have different learning rates. Take individual differences into account.
■■ Skills, especially the individual components, are quickly forgotten. Frequent practice improves skill
retention.

Instructor’s Note: Allow participants sufficient time to practice the skill until they are
able to meet performance criteria. The length of the skill session will vary based on the
complexity of the skill, the instructor-participant ratio and whether or not participants
need to take turns using equipment (e.g., manikins).
APPROACHES TO PRACTICING SKILLS

Orienting participants to the skill session will help them get started quickly and practice more efficiently.
Instructor-Led Practice
In the instructor-led practice approach, the instructor guides participants through each step of the
skill while checking on participants to ensure that all in the group complete the steps properly as the
instructor calls them out. Instructor-led practice can be used to focus on a skill or part of a skill. This
approach is particularly useful for introducing new skills that build on previously learned skills, or when
participant safety is a concern.
When you lead the practice, position yourself so that you can see everyone. It may help to have
participants’ heads pointing in the same direction and their partners in the same relative position next to
them. Being able to see everyone allows you to monitor skill performance as well as ensure participant
safety.
Partner-Based Practice
A partner-based practice approach is useful for providing participants with experience in giving care to
a real person. One participant acts as the injured or ill person while the other gives care. When using a
partner-based practice approach:
■■ Allow participants to choose their partners. Some participants may be reluctant to practice with
participants of the opposite gender. Instructors should accommodate participants’ preferences.
■■ Ensure that participants exchange roles so that each participant has a chance to practice the skill.
■■ Do not allow participants to engage in horseplay, which can lead to injury.
Instructor’s Note: For reasons of educational quality and participant safety, the
following skills taught in many American Red Cross courses are practiced only on a
manikin and never on a real person: ventilations, chest compressions and automated
external defibrillator (AED) pad placement.
Reciprocal Practice
In a reciprocal practice approach, participants working in pairs or groups observe each other’s
performance and provide guidance and feedback. The goal is for the participant doing the skill to
demonstrate the skill correctly without any assistance from their partner. For this approach to be
effective, the instructor must clearly identify the performance criteria. During reciprocal practice, move
among participants and observe to ensure that they are practicing the skills correctly and are receiving
appropriate feedback from their partners. Provide feedback as appropriate and assistance as needed.
Instructor’s Note: When using the reciprocal practice approach to skill practice, if you
observe that a participant correctly demonstrates the skill from start to finish without
assistance and at the level of proficiency indicated on the skill assessment tool, you may
check off that person’s skill on the Participant Progress Log and let the participant know
that no further demonstration of that skill is required.

Video Segments
In American Red Cross courses, video may be used in different ways to support the skill sessions.
Watch-Then-Practice
In the watch-then-practice approach to skill practice, participants watch a video segment demonstrating
the skill, and then they practice the skill. After showing the video, guide participants through the steps
of the skill (referring participants to the skill sheet as needed), and then encourage them to practice
independently without assistance. Intervene and provide positive and corrective feedback as needed.
Practice-While-You-Watch
In the practice-while-you-watch approach to skill practice, participants practice the skill along with
a video, which provides audiovisual cues. The practice-while-you-watch approach has the following
benefits:
■■ It provides a consistent model demonstration of the skill using a methodical instructional approach.
■■ It allows the instructor to focus on evaluating skill performance as the participant learns, which in turn
allows the instructor to identify and correct errors in technique earlier in the learning process.
■■ It maximizes the effectiveness of training and increases the time allotted for skill practice.
Skill Drills
Skill drills are used to help reinforce the skills learned up to that point in the lesson and require
participants to perform multiple skills in succession. Skill drills provide an immediate opportunity to put
the “total picture” into practice.
Putting It All Together Scenarios

Once new skills are learned, additional class activities provide the opportunity to practice newly learned
skills as well as use decision-making abilities in various situations. The scenarios help to reinforce
learning by drawing on participants’ skills and decision-making abilities in various situations. They are
also included as a review during which participants can recall and apply the information learned in the
course such as:
■■ First aid scenarios
■■ Putting It All Together activities
■■ Multiple-rescuer response scenarios
SETTING UP SKILL PRACTICE SESSIONS
Land-Based Skill Practice
When arranging the classroom for skills practice, ensure that there is an adequate amount of equipment
and supplies for the number of participants in the class. Arrange the skill practice area so that each
participant has ample room to view the demonstration (video or instructor), move about, practice the
skill, ask questions and receive feedback on their performance. Also ensure that you and your fellow
instructors can see the participants, move from person to person, and provide feedback and oversight at
all times. When using skill sheets, distribute copies of each sheet to each participant to use as a guide or
refer participants to the appropriate skill sheet in their participant’s manual. When participants are working
in pairs, encourage communication among the group and peer-to-peer learning using the skill sheet.

When the participants are practicing on manikins, the manikins’ heads should be pointing in the same
direction, and all the participants should be in the same position next to the manikins. If the participants
are practicing on partners, being able to see everyone allows you to judge skill competency as well as
ensure participant safety.
In-Water Skill Demonstration and Practice

In the Lifeguarding program, the in-water skills performed have multiple actions occurring
simultaneously. If necessary, skills should be demonstrated in exactly the same manner from the front,
back and both sides. This allows participants to see all sides and angles of a sequence. In some cases,
this may not be possible, such as with an entry from a lifeguard stand. However, the more participants
can see, the better they will conceptualize a skill.
If a skill is only demonstrated from one side or angle, the secondary actions may be missed and the total
picture will be incomplete. This is particularly true for skills that involve actions both above and below
the water. A demonstration by the instructor is also often included so that the participant understands
what is to be performed and has a model to follow. The instructor demonstration is also beneficial when
providing corrective feedback during skill practice sessions.
For each skill practice, organize participants so they can clearly see and hear. Pair up participants and
explain that they will take turns as a victim and rescuer for each skill. For skills and scenarios requiring
more than one rescuer, reassign participants into larger groups. Be sure to provide any instructions
related to their position in the water and how they should behave as victims. Instruct participants that
if they experience difficulty when playing the role of a victim, they should use the predetermined safety
signal, such as a tap or gentle pinch to communicate that the rescue should be immediately stopped.
Throughout the practice session, maintain a safe environment and ensure you can clearly observe class
participants. It is beneficial for certain skills to be demonstrated, and then practiced, on land first before
the in-water skill demonstration and practice. These skills include but are not limited to the submerged
victim rescue and feet-first surface dive.
RUNNING SKILL PRACTICE SESSIONS

The instructions in the skill practice sessions are condensed for ease of use. However, during every
skill practice session, circulate among groups to monitor progress and provide assistance when
necessary. For the benefit of all course participants, provide global feedback (feedback to the entire
class) during skill practice to correct common mistakes or commend correct skill practice. Participants
should practice the skills until they are able to meet performance criteria. Observe each participant’s
performance of the skill and provide corrective individual feedback using the skill charts and skill
assessment tools.
Helping Participants to Practice Correctly

Practicing a skill helps learning only when the skill is performed correctly. One of your most difficult
challenges as an instructor is to ensure that participants practice correctly. Continually monitor all
participants, watching for errors participants make while practicing. (A summary of common errors that
participants make when practicing the skills in the program can be found in Section E of this blended
manual.) Correct any problems you notice as soon as possible using global or individual feedback to
prevent participants from continuing to practice incorrectly. While you are working closely with one
participant, check others with an occasional glance. Encourage participants to ask questions if they are
unsure how to perform any part of a skill.

A positive learning environment is important. Participants perform best when you keep them informed of
their progress. When participants are practicing correctly, provide positive feedback that identifies what
they are doing correctly. If participants are practicing incorrectly, provide specific, corrective individual
feedback and have them practice again. Before saying what they are doing wrong, tell them what they
are doing correctly. Then tactfully help them improve their performance.
When giving feedback, keep the following strategies in mind:

■■ Be specific when providing feedback.
■■ If the error is simple, explain directly and positively how to correct the skill performance. For
example, if the participant is having trouble finding the proper hand placement for CPR, you might
say, “The steps leading up to beginning CPR are good; now try finding the center of the chest for
compressions. That will be the spot you want to aim for.”
■■ Show the participant what they should be doing. For example, in addition to telling the participant
that the hands should be placed in the center of the chest for compressions, demonstrate the proper
hand placement.
■■ Explaining why the skill should be performed in a certain way may help participants remember how
to perform the skill correctly. For example, if a participant continually forgets to check the scene for
safety as part of the scene size-up, you might remind the participant that failing to check for safety
before going to another’s aid can put the lifeguard at risk for injury or illness as well.
■■ If a participant has an ongoing problem with a skill, carefully observe what they are doing. Give
specific instructions for performing the skill the correct way and lead the participant through the skill.
It may help to have the participant state the steps back to you for reinforcement.
■■ Emphasize the critical performance steps, focusing on those steps that make a difference in the
successful completion of a skill.
■■ Have the participant practice again after the corrective feedback.
■■ During skill sessions, resist telling participants anecdotes, which can distract or confuse them.
■■ Remind participants what they are doing right and what they need to improve. Use phrases such as
“Your arms are lined up well, but try to keep them as straight as possible while giving compressions
to help ensure that they are effective.” Help participants focus on the critical components of each
skill.
Coaching Versus Prompting Participants

The desired outcome of each skill session is for participants to demonstrate a skill correctly from
beginning to end without receiving any assistance from you or a partner or referring to the skill sheet.
Because participants learn at different rates, bring different levels of knowledge to the course and learn
in different ways, you will most likely need to coach or guide participants as they first learn skill elements.
Coaching occurs in the initial phases of skill practice and allows you to give participants information
that they need to establish the sequence, timing, duration and technique for a particular skill. When
coaching (also known as guided practice), provide information such as the sequence of steps in a skill.
Statements such as “Size up the scene” or “Check the person for responsiveness” are examples of
coaching.
Once guided practice ends and independent demonstration of a skill begins, you should change tactics
and shift to prompting. Prompting allows you to assess the participant’s ability to make the right decision
at the right time and give the appropriate care. Because participants are expected to demonstrate the
skill without any assistance, when you prompt someone, provide only the information necessary for the
participant to make a decision and give care. In other words, you should give information only about the
conditions found. For example say, “The person is unresponsive,” instead of “Call 9-1-1.”

Evaluating Skill Performance
Skill Charts and Skill Assessment Tools are provided in this manual to assist you in evaluating
participants’ mastery of the skill. Before conducting a course, become familiar with the Skill Charts
and Skill Assessment Tools, found at the end the lesson in which the skill is practiced. Skill Charts
provide step-by-step descriptions of the skills participants must master to pass the course. The Skill
Assessment Tools summarize the objectives that must be met for correct performance of the skill,
along with descriptions of actions that constitute proficiency and non-proficiency. The Skill Assessment
Tools include specific depths, ranges, rates, intervals, times and other quantifiable elements by which
to assess skill performance. In addition to performing the steps listed in the Skill Chart in the correct
order, participants must meet the objectives listed at the proficient level on the Skill Assessment Tool
before they can be checked off for a skill. Objectives that are general for the category of skills, as well
as specific to the skill, must be met. It is your responsibility as the instructor to observe participants’
skill performance to determine whether they are performing the skill correctly with respect to sequence,
timing and duration, and whether they are meeting the established skill proficiency criteria.
Instructors must focus on the successful completion of an objective as opposed to perfecting every
individual skill. For example, a participant who has arthritis in their hands can still perform effective chest
compressions by grasping the wrist of the hand positioned on the chest with their other hand, instead
of placing one hand on top of the other and interlacing the fingers. In this example, the participant may
continue the course and still receive certification, since the skills needed to prevent injury or save a life
may need modification, but the result is the same. Additional information on adjustments to training can
be found in the American Red Cross Inclusion Resource Guide, located in the Resources section of the
Many American Red Cross courses provide Participant Progress Logs to track each participant’s
completion of the requirements for certification. During the skill session, check off each skill as
completed on the Participant Progress Log once the participant has demonstrated proficiency in it. To
complete the course requirements and receive a completion certificate, a participant must be able to
complete the required skills proficiently without any coaching or assistance.

CHAPTER 6
COURSE COMPLETION
CRITERIA FOR COURSE COMPLETION AND

CERTIFICATION
Many agencies, organizations and individuals look to the American Red Cross for formal training that
results in certification. Red Cross certification means that on a particular date, an instructor verified that
a course participant could demonstrate proficiency in all required skills taught in the course. Proficiency
is defined as being able to perform each skill to meet the objective without guidance and apply those
skills in a simulated emergency. Achieving certification does not imply any future demonstration of the
knowledge or skill at the level achieved on the particular date of course completion.
On successful completion of a course in the Lifeguarding program, participants receive American Red
Cross certification specific to the course they completed. Participants can access the digital certificate
through an email with a link once the course has been closed. Participants who took a blended learning
class can also view their certificates on the Red Cross Learning Center—Student Portal. The digital
certification will contain an alpha-numeric identifier and Quick Response (QR) code and can be viewed,
printed or shared online.
To successfully complete the Lifeguarding Blended Learning course, the participant must:
■■ Attend the entire course and participate in all class sessions.
■■ Actively participate in all course activities, including assuming various roles during scenarios.
■■ Demonstrate competency in all required skills.
■■ Pass the final skills scenarios.
■■ Complete all eLearning content, including the eLearning written exam (CPR/AED for Professional
Rescuers and First Aid).
■■ Successfully pass final written exams with a minimum grade of 80 percent. If a participant fails to
reach the minimum 80 percent on the final written exam, a retest is allowed using the other version of
the exam, provided that the learner has passed the final skills assessment.
Participants must be told of the requirements when they enroll for the course and again during the
course introduction. Remember to provide ongoing individual feedback to participants about their
performance throughout the course. Feedback should be ongoing, so there are no surprises if a
participant’s performance is evaluated as unacceptable.
SKILL COMPETENCY
To complete the course requirements and receive a completion certificate, a participant must be able to
complete all required skills proficiently without any coaching or assistance. A participant’s performance
is proficient or not proficient based on the performance of the critical components of a skill that are
necessary to meet the objective.

FINAL WRITTEN EXAMS
There are two versions of each written exam, and thus, participants have two opportunities to take each
exam. Participants are required to answer the questions without assistance from the instructor trainer. If
an accommodation is requested by the participant, the instructor trainer may read the exam questions to
the participant. Participants are required to pass both final written exams in order to receive certification
in American Red Cross Lifeguarding/First Aid/CPR/AED. Final written exams to support the modules in
the Lifeguarding program are available on the Red Cross Learning Center.
Administering Exams
When administering a written exam, you must use the exam provided and may not substitute exam
questions. Either Exam A or Exam B can be used. Administer only those exams for the components that
are included in the course (shown below) being taught:
■■ Lifeguarding
■■ Shallow Water Lifeguarding
■■ Aquatic Attraction Lifeguarding
■■ CPR/AED for Professional Rescuers and First Aid*
■■ Waterfront Skills
■■ Waterpark Skills
*Completed at the conclusion of the eLearning section.
To pass the written exam, participants must score 80 percent or better on each exam section. If a
participant does not achieve a score of 80 percent, they have the opportunity to take the alternative
exam. Instructors may allow participants who passed the exam to review questions they missed;
however, graded answer sheets and written exams must be returned to the instructor.
Instructor’s Note: It is acceptable for an instructor/proctor to read the exam to a

participant as long as the participant determines the appropriate response.
Maintaining Exam Security

Exam security is the instructor’s responsibility. It is not recommended that participants be allowed to see
the written exam before it is distributed. Instruct participants to put away all course materials and mobile
devices. As participants hand in their answer sheets, you may quickly grade the exam (using the answer
keys located in Appendix G of this manual) and return it to the participant. This way, the participant can
review any incorrect answers. Be sure to collect all answer sheets and exams before participants leave
the class. Exams may be updated periodically and it is the responsibility of the instructor to ensure that
they are using the most current exam.
FINAL (IN-WATER) SKILLS SCENARIOS

Participant skills are evaluated and feedback given throughout the course. The purpose of the final in-
water skill scenarios is to ensure that participants have achieved a level of competency and retention of
the skills learned in the course.
Participants will have to demonstrate competency in the following areas for the Lifeguarding course:
■■ Scenario 1: Passive Submerged Victim Rescue with Extrication (including CPR)
■■ Scenario 2: Multiple-Rescuer Response Scenario 3

CRITERIA FOR GRADING PARTICIPANTS
Course participants are assigned one of the following grades:
■■ Successful is entered for a participant who has successfully attended and participated in all class
sessions, including activities and skill sessions, and demonstrated proficient competency in all
required skills.
■■ Unsuccessful is entered for a participant who has not met course objectives and/or has not
successfully attended and participated in all class sessions, including activities and skill sessions, or
demonstrated proficient competency in all required skills.
■■ Not Evaluated is entered as the final grade for a participant who is not attending the course with the
intention of receiving a completion certificate. This grade should not be substituted for Unsuccessful
for a participant who attempts certification but is unable to pass the completion requirements. A
participant who chooses to audit must make their intent known to the instructor at the beginning of
the class.
When conducting Final Skill Scenario 2: Multiple-Rescuer Response Scenario 3, evaluate participants
on both:
■■ Individual performance and their ability to achieve skill competencies for the individual skill(s) that they
are responsible for.
■■ Overall team response performance, demonstrating the ability to work effectively as part of a team
to prioritize care, take action without following an assigned role and communicate with fellow
responders.
Instructor’s Note: Use the multiple-rescuer response assessment tool in Appendix F.

If an individual receives a “fail” in any skill of the scenario, they receive an overall “fail”
rating. If the team receives a “fail” rating, each lifeguard on the team receives a “fail”
rating. It is possible for the overall team to receive a “pass” rating but one of the lifeguards
to receive a “fail.”
HANDLING UNSUCCESSFUL COURSE COMPLETION

If a participant does not meet the criteria for course completion and certification, provide the participant
with information about course topics and skills where remediation is needed. Advise the participant that
they can repeat the course if they choose.
REPORTING PROCEDURES
You must close the course in the Red Cross Learning Center within the specified time frame (10 days).
Instructions for using and submitting records are available in the Resources section of the Red Cross
Learning Center.

ACKNOWLEDGING COURSE COMPLETION
Awarding Certification
Red Cross certification means that on a particular date an instructor verified that a participant
demonstrated competency in all required skills taught in the course, including successfully completing
both the written exam and skills assessment.
When closing the course, instructors must include the email address of each participant so they can
receive an email with a link to their digital certificate.
Participants can access the digital certificate through an email with a link once the course has been
closed, or candidates can access their certificate by going to directly to the site. Participants can also
view their certificates on the Red Cross Learning Center—Student Portal.
The digital certificate can be viewed, printed or shared online. It will contain an alpha-numeric identifier
and Quick Response (QR) code.
Continuing Education Units for Professionals

Many course-takers are professionals who need continuing education units to maintain a license, a
certification or both. The American Red Cross is an accredited provider of the International Association
of Continuing Education and Training (IACET). IACET’s Criteria for Quality Continuing Education and
Training Programs are the standards by which hundreds of organizations measure their educational
offerings. For additional information, please see the Red Cross Learning Center or
redcross.org.
OBTAINING PARTICIPANT FEEDBACK

Gaining feedback from participants is an important step in any evaluation process. Participants should
have an opportunity to tell you what they thought about the course. Have participants complete
evaluations each time you teach the course. This information will provide you with feedback concerning
the course and its instruction and help the Red Cross maintain the high quality of the course.
ADDITIONAL TRAINING OPPORTUNITIES

A wide range of additional training opportunities in safety and preparedness are offered through the
American Red Cross. Examples include:
■■ Swimming and Water Safety
■■ Lifeguarding Instructor
■■ Water Safety Instructor
■■ Basic Swim Instructor
■■ First Aid for High School Coaches
■■ Anaphylaxis and Epinephrine Auto-Injector Training
■■ Basic Life Support for Health Care Providers
■■ Wilderness and Remote First Aid
■■ Babysitter’s Training and Advanced Child Care Training
Refer participants to redcross.org for more information about scheduled courses in their community.

SECTION B | COURSE OUTLINE
LIFEGUARDING BLENDED
SECTION B | LEARNING COURSE EXTENDED
OUTLINE
L—Lecture/Guided Discussion | A—Activity | V—Video
WSP—Water Skills Practice | LSP—Land Skills Practice
PRECOURSE SESSION
TOPIC LESSON METHOD TIME
Introduction to the Precourse Skills Session Precourse A 10 minutes
Verification of Age Prerequisite Precourse A 5 minutes
Prerequisite Swimming Skills Evaluation Precourse A 40 minutes
Wrap-Up Precourse L 5 minutes
Total Session Time 1 hour
LESSON 1: THE PROFESSIONAL LIFEGUARD

Introduction to the Course 1 L 5 minutes
Being Part of a Team 1 L, A 10 minutes
Total Session Time 15 minutes

LESSON 2: FACILITY SAFETY AND PATRON
SURVEILLANCE
■■ Facility Safety and the Drowning 2 L 5 minutes
Process
In-Water Skill Session: Entries and
Approaches
■■ Skill Practice 2 WSP 40 minutes
■■ Skill Drill
Total Session Time 45 minutes
LESSON 3: INJURY PREVENTION

Injury Prevention 3 L 5 minutes
In-Water Skill Session: Review Skills,
Victim Recognition and Rotations
■■ Victim School 3 WSP 35 minutes
■■ Scanning & Lifeguard Rotations
Putting It All Together

■■ Brick Drill
■■ Rescue Tube Relay 3 WSP 35 minutes
■■ Ask Drill
Total Session Time 1 hour, 15

minutes

LESSON 4: WATER RESCUE SKILLS
In-Water Skill Session: Rescue Skills, Part 1
■■ Skill Practice
cc Reaching Assist
cc Simple Assist
4 WSP 1 hour, 25
cc Active Victim Front Rescue
minutes
cc Active Victim Rear Rescue
cc Passive Victim Front Rescue
cc Passive Victim Rear Rescue
cc Multiple Victim Rescue
■■ Skill Drill

4 WSP 35 minutes
■■ EAP Activity
In-Water Skill Session: Rescue Skills, Part 2

cc Feet-first surface dive
cc Head-first surface dive
cc Submerged victim rescue in deep
4 WSP 1 hour, 10
water minutes
cc Extrication

■■ Skill drill – parts 1, 2, 3, 4
cc Put on gloves with wet hands
cc Rescue, extricate, gloves
cc Challenge: Rescue and extrication in
4 WSP 1 hour
under 1 minute
cc Extrication with two assisting
responders
Total Session Time 4 hours, 10
minutes

LESSON 5: BEFORE PROVIDING CARE, VICTIM
ASSESSMENT AND BREATHING
EMERGENCIES
Standard Precautions and Glove Removal 5 L 5 minutes
General Procedures for an Emergency on 5 L 5 minutes
Land
Performing a Primary Assessment
■■ Adult practice
■■ Using a Resuscitation Mask practice 5 L, LSP 35 minutes
■■ Infant practice
■■ Summoning EMS
Moving a Victim 5 L 5 minutes

Recognizing and Caring for Breathing 5 L 5 minutes
Emergencies
Giving Ventilations (PWYW or WTP)
■■ Adult 5 V, LSP 15 minutes
■■ Infant
Giving Ventilations Using a Bag-Valve-

Mask Resuscitator 5 V, LSP 15 minutes
■■ Giving Ventilations Using a Bag-Valve-
Mask Resuscitator—Two Rescuers
Airway Obstruction
■■ Conscious Choking—Adult and Child 5 V, LSP 15 minutes
■■ Conscious Choking—Infant
Total Session Time 1 hour, 40

minutes

LESSON 6: CARDIAC EMERGENCIES AND USING AN
AUTOMATED EXTERNAL DEFIBRILLATOR
Cardiac Arrest 6 L 5 minutes
CPR (PWYW/WTP)
■■ CPR—Adult 6 V, LSP 40 minutes
■■ CPR—Infant
Two-Rescuer CPR
■■ Two-Rescuer CPR—Adult 6 V, LSP 15 minutes
■■ Two-Rescuer CPR—Infant
When the Heart Stops and AEDs 6 L 5 minutes

Using an AED
■■ Using an AED (adult, child or infant) 6 L, LSP 10 minutes
■■ Using and AED—CPR in Progress
CPR with Airway Obstruction

■■ CPR with Airway Obstruction—Adult 6 L, A 10 minutes
■■ CPR with Airway Obstruction—Infant
In-Water Skill Session: Putting It All

Together
■■ Skill Drill Part 1 and 2:
Part 1: Submerged Victim Rescue,
Extrication, Primary Assessment and 6 WSP/LSP 45 minutes
Ventilations
Part 2: Lifeguard Station Response Time
Testing
Putting it All Together: Multiple-Rescuer
Response 6 V, LSP 1 hour, 5
minutes
Skill Drill (Scenarios 1-4)
Total Session Time 3 hours,15
minutes

LESSON 7: FIRST AID
Secondary Assessment 7 L 5 minutes
Responding to Emergencies
■■ Controlling Bleeding 7 LSP, A 25 minutes
■■ Shock
■■ Common Injuries
Putting It All Together—First Aid Scenarios 7 A 20 minutes
In-Water Skill Session—When Things Do

Not Go As Practiced 7 WSP 30 minutes
■■ Escapes
■■ In-Water Ventilations
In-Water Skill Session—Rescue Skills

Review
■■ Submerged passive rescue--shallow
■■ Passive Victim Front Rescue
■■ Passive Victim Rear Rescue 7 WSP/LSP 45 minutes
■■ Submerged Passive Victim in Deep
Water
■■ Extrication Using a Backboard at the
Pool Edge
■■ Multiple-Rescuer Response—Scenarios
5 and 6
minutes

LESSON 8: HEAD, NECK AND SPINAL INJURIES IN THE
WATER
Caring for Head, Neck and Spinal Injuries 8 L 5 minutes
in the Water
In-Water Skill Session: Head, Neck and
Spinal Injuries
■■ Skill Practice—Shallow Water
cc Over-Arm Head Splint—Face-Up
cc Head Splint—Face-Down 2 hours, 20
8 WSP minutes
cc Spinal Backboarding Procedure
cc Spinal Backboarding Procedure—For
Facilities with High Edges
■■ Skill Practice—Deep Water
cc Head Splint—Face-Down
cc Head Splint—Submerged

minutes
LESSON 9: FINAL WRITTEN EXAM AND FINAL IN-WATER

SKILL SCENARIOS
Final Written Exam: Section 2— 9 A 30 minutes
Lifeguarding Skills
In-Water Skill Session: General Skills 9 A (30 minutes)
Review (optional)
Final In-Water Skill Scenarios
■■ Scenario 1: Submerged Passive Victim 9 A 2 hours, 30
in Deep Water with Extrication, Primary minutes
Assessment and CPR
■■ Scenario 2: Multiple-Rescuer Response
Closing 9 L 5 minutes
minutes
TOTAL COURSE TIME.......................................................................................................19 hours, 55 minutes

SECTION B | INTENSIVE OUTLINE
LIFEGUARDING BLENDED LEARNING

SECTION B | COURSE INTENSIVE OUTLINE
This blended learning course outline has been adjusted to a three-day intensive format. This allows
participants to complete all of the eLearning information and view the videos for skills prior to the in-
person session. Please see the lesson number in the outline that corresponds to the lesson topic
location.
When teaching the intensive format, consider conducting the precourse session one week in
advance of the first classroom session, if possible. This will allow you to provide participants with the
intensive course outline schedule, the eLearning information and the participant's manual with reading
assignments. When offering this intensive course, instructors must ensure that participants have ample
time to complete all eLearning content prior to the first classroom session. Participants must provide
proof of completion before attending Session 1.
In addition to completing the eLearning content, it is recommended that participants complete the
review questions at the end of each chapter in the Lifeguarding Manual, prior to attending Session 1.
Note: This intensive outline includes several hours of physical skills each day. Provide breaks as
appropriate to allow participants time to rest and recover.
L—Lecture/Guided Discussion | A—Activity | V—Video

WSP—Water Skills Practice or Activity | LSP—Land Skill Practice
PRECOURSE SESSION:
Introduction to the Precourse Skills Session Precourse A 10 minutes
Verification of Age Prerequisite Precourse A 5 minutes
Prerequisite Swimming Skills Evaluation Precourse A 40 minutes
Wrap-Up Precourse L 5 minutes
Total Session Time 1 hour

SESSION 1: THE PROFESSIONAL LIFEGUARD AND
FACILITY SAFETY, PATRON SURVEILLANCE,
ENTRIES AND APPROACHES

Introduction to the Course 1 L 5 minutes
Being a Part of a Team 1 L, A 10 minutes
Facility Safety and the Drowning Process 2 L 5 minutes
In-Water Skill Session: Entries and Approaches

■■ Skill Practice 2 WSP 40 minutes
■■ Skill Drill
Injury Prevention 3 L 5 minutes
In-Water Skill Session: Review Skills, Victim

Recognition and Rotations
■■ Victim School 3 WSP 35 minutes
■■ Effective Scanning & Lifeguard Rotations

■■ Brick Drill
3 WSP 35 minutes
■■ Rescue Tube Relay
■■ Ask Drill

minutes

SESSION 2: IN-WATER SKILL SESSIONS, EMERGENCY
ACTION PLANS, STANDARD PRECAUTIONS,
INJURY PREVENTION, RESCUE SKILLS AND
CPR AND AEDS
In-Water Skill Session—Rescue Skills, Part 1
cc Reaching Assist
cc Simple Assist
cc Active Victim Front Rescue 1 hour, 25
4 WSP minutes
cc Passive Victim Front Rescue
■■ Skill Drill

4 WSP 35 minutes
■■ EAP Activity
In-Water Skill Session—Rescue Skills, Part 2

cc Feet-First Surface Dive
cc Head-First Surface Dive 4 WSP 1 hour, 10
cc Submerged Victim Rescue in Deep Water minutes
cc Extrication

■■ Skill Drill—Parts 1, 2, 3, 4
cc Put on gloves with wet hands
cc Rescue, extricate, gloves 4 WSP 1 hour
cc Challenge: Rescue and extrication in under
1 minute
cc Extrication with two assisting responders
Standard Precautions and Glove Removal 5 L 5 minutes
General Procedurs for an Emergency on Land 5 L 5 minutes
Performing a Primary Assessment
■■ Adult practice
■■ Using a Resuscitation Mask practice 5 L, LSP 35 minutes
■■ Infant practice
■■ Summoning EMS
Moving a Victim 5 L 5 minutes

Recognizing and Caring for Breathing 5 L 5 minutes
Emergencies

SESSION 2 TOPIC, CONTINUED LESSON METHOD TIME
Giving Ventilations (PWYW or WTP)
■■ Adult 5 V, LSP 15 minutes
■■ Infant
Giving Ventilations Using a Bag-Valve-Mask

Resuscitator
■■ Giving Ventilations Using a Bag-Valve-Mask 5 V, LSP 15 minutes
Resuscitator—Two Rescuers
Airway Obstruction
■■ Conscious Choking—Adult and Child 5 V, LSP 15 minutes
■■ Conscious Choking—Infant
Cardiac Arrest 6 L 5 minutes

CPR (PWYW or WTP)
■■ CPR—Adult 6 V, LSP 40 minutes
■■ CPR—Infant
Two-Rescuer CPR
■■ Two-Rescuer CPR—Adult and Child 6 V, LSP 15 minutes
■■ Two-Rescuer CPR—Infant
When the Heart Stops and AEDs 6 L 5 minutes

Using an AED
■■ Using an AED (adult, child or infant) 6 L, LSP 10 minutes
■■ Using an AED—CPR in Progress
CPR with Airway Obstruction

■■ CPR with Airway Obstruction—Adult 9
L, A 10 minutes
■■ CPR with Airway Obstruction—Infant
In-Water Skill Session: Putting It All Together

■■ Skill Drill Part 1 and 2:
Part 1: Submerged Victim Rescue, Extrication, 6 WSP/LSP 45 minutes
Primary Assessment and Ventilations
Part 2: Lifeguard Station Response Time Testing

Response
6 V, LSP 1 hour, 5
minutes
Skill Drill (Scenarios 1-4)

minutes

SESSION 3: SECONDARY ASSESSMENT, RESPONDING
TO EMERGENCIES, HEAD, NECK AND
SPINAL INJURIES IN THE WATER; RESCUE
SKILLS; FINAL SKILL SCENARIOS AND
FINAL WRITTEN EXAM

Secondary Assessment 7 L 5 minutes
Responding to Emergencies
■■ Controlling Bleeding 7 LSP, A 25 minutes
■■ Shock
■■ Common Injuries
Putting It All Together—First Aid Scenarios 7 A 20 minutes

In-Water Skill Session—When Things Do Not Go
As Practiced 7 WSP 30 minutes
■■ Escapes
■■ In-Water ventilations
In-Water Skill Session—Rescue Skills Review

■■ Submerged Passive rescue--shallow
■■ Passive Victim Front Rescue 7 WSP/LSP 45 minutes
■■ Passive Victim Rear Rescue
■■ Submerged Passive Victim in Deep Water
■■ Extrication Using a Backboard at the Pool Edge
■■ Multiple-Rescuer Response—Scenarios 5 and
6
Caring for Head, Neck and Spinal Injuries in the 8 L 5 minutes
Water
In-Water Skill Session: Head, Neck and Spinal
Injuries
■■ Skill Practice—Shallow Water
cc Over-Arm Head Splint—Face-up
cc Head Splint—Face-down 2 hours, 20
8 WSP
cc Spinal Backboarding Procedure minutes
cc Spinal Backboarding Procedure—For
Facilities with High Edges
■■ Skill Practice—Deep Water
cc Head Splint—Face Down
cc Head Splint—Submerged
Final Written Exam: Section 2—Lifeguarding Skills 9 A 30 minutes
In-Water Skill Session: General Skills Review - 9 A (30 minutes)

optional

SESSION 3 TOPIC, CONTINUED LESSON METHOD TIME
Final In-Water Skill Scenarios
■■ Scenario 1: Submerged Passive Victim in Deep 9 A 2 hours, 30
Water with Extrication, Primary Assessment minutes
and CPR
■■ Scenario 2: Multiple-Rescuer Response
Closing 9 L 5 minutes
minutes
TOTAL COURSE TIME.......................................................................................................19 hours, 55 minutes

PRECOURSE SESSION
PRECOURSE SESSION
Lesson Length: 1 hour
GUIDANCE FOR THE INSTRUCTOR

To complete this session and meet the lesson objectives, you must:
■■ Verify participant age.
■■ Conduct the prerequisite swimming skills evaluation.
■■ Conduct the lesson wrap-up.
SESSION OBJECTIVES
After completing this lesson, successful participants must be able to:
■■ Meet the age requirement.
■■ Demonstrate proficiency in all of the prerequisite skills.
MATERIALS, EQUIPMENT AND SUPPLIES

■■ Timing device, such as a stopwatch or smartphone with a stopwatch feature
■■ 10lb object (a diving brick or weight; one for every five participants)
■■ Lifeguarding Precourse Skills Checklist
LESSON PREPARATION
Send participants the Sample Letter to Lifeguarding Blended Learning Course Participants,
■■
available in Appendix A and on the Red Cross Learning Center, to set expectations, provide the
eLearning direct link and help participants prepare for the course.
■■ To save time, have all equipment and materials set up before the start of the class.
■■ Fill in the lifeguarding participant names on the Lifeguarding Precourse Skills Checklist.
INSTRUCTOR NOTES
■■ When reviewing the prerequisite skills with participants, only cover the course and/or modules
you are teaching. Have participants perform the prerequisite skills only for the course and/or
module you are teaching.
■■ The prerequisite swimming skills evaluation is designed to assess the individual’s strength,
endurance and comfort in the water. If a candidate is not successful on the first attempt at the
prerequisite skills, they have only one opportunity to re-attempt the prerequisites after sufficient
rest, prior to the first scheduled class session.
■■ When determining a participant’s ability to pass the prerequisite swimming skills evaluation
and successfully participate in the course, the instructor must evaluate the individual’s overall
performance.

■■ The individual should not be judged on stroke mechanics, but rather on their overall
demonstration of swimming strength, endurance, comfort in the water and ability to meet the
time requirements.
■■ Participants may use goggles for the 300-yard swim. This is the only activity where participants
are permitted to use goggles. Participants may not use goggles for the timed event, treading
water or other Lifeguarding course activities.
■■ Participants may wear contact lenses during the course, but may not use protective eyewear/
goggles during the courses.
■■ During the timed precourse event, participants must retrieve a 10-pound object such as a dive
brick or weight; after retrieving the object, participants must swim on their back with both hands
on the object.
■■ If a Waterfront Skills module is scheduled to immediately follow the Lifeguarding course and
all candidates are enrolled in both the Lifeguarding course and Waterfront Skills module,
you should conduct the precourse session for the Waterfront Skills module instead of the
Lifeguarding precourse session.
■■ If the prerequisite evaluation for Waterfront Lifeguarding is not completed at this time, then it
must be completed as a precourse session for the Waterfront Skills module.
■■ Counseling after the Precourse Session: On an individual basis, after the precourse session
has ended, advise each participant who did not meet the prerequisites that:
cc Entry into the Red Cross Lifeguarding course is strictly limited to those who meet the
minimum age requirement and have successfully completed the prerequisite swimming skills
evaluation.
cc Failure to have attained the appropriate skill level could pose a safety threat to themselves
and to others in the class.
cc Participants who do not successfully complete the precourse evaluation may not continue in
the course.
●● Instructors should suggest developmental training opportunities and explain the specific
skills that the individual needs to improve to be eligible should the candidate choose to
participate in the Lifeguarding course in the future.
■■ When teaching the Lifeguarding course, if the maximum water depth is 6 feet, an alternate
timed event is permitted as described in the swimming skills evaluation section below.
■■ The treading water prerequisite skill for the Shallow Water Lifeguarding course should be
conducted in a minimum of 5 feet. Taller participants should lean slightly forward if needed
while treading to keep from touching the bottom.
■■ When teaching the Aquatic Attraction Lifeguarding course, the water competency sequence
must be performed in water that is deep enough for participants to jump in and fully submerge
without touching the bottom (a minimum depth of 5 feet).
■■ Participants must have access to their own manual throughout the course in either digital or
print format. When using a digital manual, a tablet or laptop should be used to ensure proper
viewing. (The manual should not be displayed on a cell phone.)
TEACHING TIPS
■■ You must be able to observe and evaluate each participant’s skills during the prerequisite
swimming skills evaluation.
■■ Consider conducting the prerequisite skills evaluation on a different day prior to the start of the
course.
■■ Encourage participants to complete the review questions after reading each chapter of the
participant’s manual throughout the course.

INSTRUCTION Discussion Lecture Skill Practice
KEY:
Activity Video Skill Drill
TOPIC: I NTRODUCTION TO THE Time: 10 minutes

PRECOURSE SESSION
VERIFICATION OF AGE AND TRAINING
ACTIVITY: ■■ Welcome prospective participants and introduce yourself. Identify yourself as an
American Red Cross instructor. Briefly tell about your background in aquatics.
Include introductions of co-instructors and aides, if applicable.
■■ Review facility policies, including emergency procedures. Give the locations of
restrooms, locker rooms, water fountains and details unique to your facility. Also,
identify the location of the automated external defibrillator (AED) and first aid kit.
■■ Have participants briefly introduce themselves.
■■ Explain that the purpose of the Lifeguarding course is to teach the knowledge
and skills needed to help prevent and respond to aquatic emergencies. This
includes land and water rescue skills as well as first aid and CPR/AED.
■■ SHALLOW WATER LIFEGUARDING
For the Shallow Water Lifeguarding course, explain that the purpose of the
course is to teach the knowledge and skills needed to help prevent and
respond to aquatic emergencies in water up to 5 feet deep.
■■ Explain to prospective participants that this precourse session is designed
to evaluate their swimming skills. Participants who successfully complete the
precourse skills evaluation should be able to participate in the Red Cross
Lifeguarding course.
Instructor’s Note: Review the prerequisite skills only for the

course and/or modules you are teaching.
■■ Review the prerequisite skills to be performed for their course and/or module:
cc Lifeguarding course or Waterpark Skills module prerequisite skills:
1. Swim 300 yards continuously demonstrating breath control and rhythmic
breathing. Candidates may swim using the front crawl, breaststroke or
a combination of both but swimming on the back or side is not allowed.
Swim goggles may be used.
2. Tread water for 2 minutes using only the legs. Candidates should place
their hands under the armpits.
3. Complete a timed event within 1 minute, 40 seconds.
●● Starting in the water, swim 20 yards. The face may be in or out of the
water. Swim goggles are not allowed.
●● Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve
a 10-pound object.
●● Return to the surface and swim 20 yards on the back to return to the
starting point with both hands holding the object and keeping the face
at or near the surface so they are able to get a breath. Candidates
should not swim the distance under water.
●● Exit the water without using a ladder or steps.

ACTIVITY: cc Waterfront Skills module prerequisite skills:
continued 1. Swim 550 yards continuously demonstrating breath control and rhythmic
Swim goggles are allowed.
3. Complete a timed event within 1 minute, 40 seconds.
●● Starting in the water, swim 20 yards. The face may be in or out of the
water. Swim goggles are not allowed.
●● Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve
a 10-pound object.
●● Return to the surface and swim 20 yards on the back to return to the
at or near the surface so they are able to get a breath. Candidates
4. Swim 5 yards, submerge and retrieve three dive rings placed 5 yards
apart in 4 to 7 feet of water, resurface and continue to swim another 5
yards to complete the skill sequence.
cc Shallow Water Lifeguarding course prerequisite skills:
1. Swim 100 yards continuously demonstrating breath control and rhythmic
Swim goggles are allowed.
3. Complete a timed event within 50 seconds.
●● Starting in the water, swim 20 yards using the front crawl or
breaststroke. The face may be in or out of the water. Swim goggles are
not allowed.
●● Submerge to a depth of 4 to 5 feet to retrieve a 10-pound object.
●● Return to the surface and walk or swim 20 yards on the back to return
to the starting point with both hands holding the object at the surface of
the water.
cc Aquatic Attraction Lifeguarding course prerequisite skills:
1. Complete the water competency sequence without stopping.
●● Step into water from the side and totally submerge.
●● Maintain position for 1 minute by treading water or floating (or a

combination of the two).
●● Rotate one full turn and orient to the exit.
●● Level off and swim on the front or back 25 yards.
●● Exit without using a ladder or steps.
2. Complete a timed event within 50 seconds without stopping.

●● Starting in the water, walk or swim 20 yards.
●● Submerge to a depth of 3 feet to retrieve a 10-pound object.
●● Return to the surface and walk or swim 20 yards on the back to return
to the starting point with both hands holding the object at the surface
of the water.
●● Exit the water without using steps or a ladder.

ACTIVITY:
continued
Instructor’s Note:
■■ When teaching the Lifeguarding course, if the maximum water
depth is 6 feet, an alternate timed event is permitted.
■■ The treading water prerequisite skill for the Shallow Water
Lifeguarding course should be conducted in a minimum of 5 feet.
■■ If a Waterfront Skills module is scheduled to immediately follow the Lifeguarding

course and all candidates are enrolled in both the Lifeguarding course and
Waterfront Skills module, you should conduct the precourse session for the
Waterfront Skills module instead of the Lifeguarding precourse session.
■■ If the prerequisite evaluation for Waterfront Lifeguarding is not completed at this
time, then it must be completed as a precourse session for the Waterfront Skills
module.
■■ When teaching the Aquatic Attraction Lifeguarding course, the water
competency sequence must be performed in water that is deep enough for
participants to jump in and fully submerge without touching the bottom (a
minimum depth of 5 feet).
Science Note: Swim goggles should only be worn for the

prerequisite swim for a variety of reasons:
■■ Swim goggles are not part of any standard issue
lifeguarding equipment protocol used in making a land or
water rescue.
■■ Swim goggles are designed for preventing water entry and
irritation and not to protect from trauma to the eye. Swim
goggles present a greatly reduced surface area at the
point of contact with tissue around the eye. The potential
for serious eye injury is greatly increased by the swim
goggle being contacted by an external object (or another
participant) during the course.
■■ Submerging to a depth of 5 feet or greater has the potential
to cause barotraumas to the eye of an individual wearing
swim goggles that cannot be pressure equalized.
TOPIC: V
ERIFICATION OF AGE Time: 5 minutes
PREREQUISITE
VERIFICATION OF AGE PREREQUISITE
ACTIVITY: ■■ Tell participants that to participate in any Red Cross Lifeguarding course or
module, they must be at least 15 years of age on or before the final scheduled
session of this course.
■■ Verify the eligibility of participants to participate in the course by checking their
proof of age, which can be a driver’s license, state identification, birth certificate
or passport.
■■ If an individual does not meet the age requirements for course participation,
suggest that they enroll in the next available Lifeguarding course once the age
requirement is met.
■■ Orient them to the locker rooms and the pool area where they are to meet for the
prerequisite swimming skills evaluation.

TOPIC: P
REREQUISITE SWIMMING SKILLS Time: 40 minutes
EVALUATION
PREREQUISITE SWIMMING SKILLS EVALUATION
ACTIVITY: ■■ Explain to prospective participants that they must successfully complete three
swimming prerequisites to continue in the Lifeguarding course.
■■ Refer to the Skill Assessment Chart to evaluate performance of each prospective
participant. Record completion of each skill on the Lifeguarding Precourse Skills
Checklist.
Instructor’s Note: Have participants perform the prerequisite

skills only for the course and/or module you are teaching.
LIFEGUARDING COURSE AND WATERPARK SKILLS MODULE

□ □ Prerequisite 1— ■■ Explain to prospective participants that they must perform a 300-yard
300-Yard Swim continuous swim using the front crawl, breaststroke or a combination of both.
Swimming on the back or side is not permitted. Swim goggles are allowed.
□ □ Prerequisite 2 — ■■ Explain to prospective participants that they must tread water for 2 minutes
Tread Water without support and without stopping. When treading, only the legs can be
used. Candidates should place their hands under the armpits. The head must
remain above the surface of the water.
□ □ Prerequisite 3— ■■ Arrange the swim distance of 20 yards and place a 10-pound object at a
Timed Event depth of 7 to 10 feet.
■■ Explain that goggles are not allowed for this event.
■■ Evaluate each prospective participant on the following skill to be performed
within 1 minute and 40 seconds.
cc Starting in the water, swim 20 yards. The face may be in or out of the water.
cc Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a
10-pound object.
cc Return to the surface and swim 20 yards on the back to return to the
starting point with both hands holding the object and keeping the face at
or near the surface so they are able to get a breath. The participants should
not swim the distance under water.
cc Exit the water without using a ladder or steps.
■■ For pools with maximum water depth of 6 feet deep, candidates should
complete the following alternate timed event:
cc Starting in the water, swim at the surface for 20 yards. The face may be in or
out of the water. Swim goggles are not allowed.
cc Surface dive to a depth of 6 feet, swim 10 to 15 feet along the bottom and
retrieve a 10-pound object.
cc Return to the surface and swim on the back to the starting point with
both hands holding the object at the surface and the face remaining at or
near the surface or able to get a breath. Candidates should not swim the
distance underwater.

WATERFRONT SKILLS MODULE
□ □ Prerequisite 2— ■■ Explain to prospective participants that they must tread water for 2 minutes
■■ Evaluate each participant on the following skill to be performed within 1
minute and 40 seconds.
cc Starting in the water, swim 20 yards using the front crawl or breaststroke.
The face may be in or out of the water.
cc Surface dive, feet-first or head-first, to a depth of 7 to 10 feet to retrieve a
10-pound object.
cc Return to the surface and swim 20 yards on the back to return to the
at or near the surface so they are able to get a breath. The participants
□ □ Prerequisite 4— ■■ Arrange the swim distance area, placing three dive rings 5 yards apart in 4 to
Underwater Swim 7 feet of water.
■■ Evaluate each participant on the following skill.
cc Starting in the water, swim 5 yards. The face may be in or out of the water.
cc Submerge, swim under water and retrieve three dive rings placed 5 yards
apart in 4 to 7 feet of water.
cc Return to the surface after picking up all three dive rings and continue to
swim another 5 yards to complete the skill sequence.
SHALLOW WATER LIFEGUARDING COURSE
□ □ Prerequisite 2— Explain to prospective participants that they must tread water for 2 minutes
■■
■■ Evaluate each participant on the following skill to be performed within 50 seconds.
cc Starting in the water, swim 20 yards using the front crawl or breaststroke or
a combination of both. The face may be in or out of the water.
cc Submerge to a depth of 4 to 5 feet to retrieve a 10-pound object.
cc Return to the surface and walk or swim 20 yards on the back to return to the
starting point with both hands holding the object at the surface of the water.

□ □ Prerequisite
AQUATIC ATTRACTION
2— LIFEGUARDING
■■ Complete COURSE
a timed event within 50 seconds without stopping.
Timed Event
cc Starting in the water, walk or swim 20 yards
□ □ Prerequisite 1— ■■ Complete the water competency sequence without stopping.
Water cc Submerge to a depth of 3 feet to retrieve a 10lb object
cc Step into water from the side and totally submerge.
Competency cc Return to the surface and walk or swim 20 yards to return to the starting
Sequence cc Recover to the surface, then maintain position for 1 minute by treading
waterpoint with both
(or ahands holding of
thethe
object
or floating combination two).at the surface of the water.
cc Exit the water without using steps or a ladder.
cc Rotate one full turn and orient to the exit.
cc Level off and swim on the front or back 25 yards.
cc Exit without using a ladder or steps.
Instructor’s Note: The water competency sequence must be

performed in water that is deep enough for participants to jump
in and fully submerge without touching the bottom (a minimum
depth of 5 feet).
□ □ Prerequisite 2— ■■ Complete a timed event within 50 seconds without stopping.

Timed Event
cc Starting in the water, walk or swim 20 yards.
cc Submerge to a depth of 3 feet to retrieve a 10-pound object.
cc Return to the surface and walk or swim 20 yards to return to the starting
point with both hands holding the object at the surface of the water.
Instructor’s Note: When determining a participant’s ability to

pass the prerequisite swimming skills evaluation and successfully
participate in the course, the instructor must evaluate the
individual’s overall performance. The prerequisite swimming
skills evaluation is designed to assess the individual’s strength,
endurance and comfort in the water. The individual should
not be judged on stroke mechanics, but rather on their overall
demonstration of swimming strength, endurance, comfort in the
water and ability to meet the time requirements.
If a candidate is not successful on the first attempt, they have
only one opportunity to reattempt the prerequisites after sufficient
rest. Instructors may suggest developmental training opportunities
and explain the specific skills that the individual needs to improve
to be eligible should the candidate choose to participate in the
Lifeguarding course in the future.

TOPIC: WRAP-UP Time: 5 minutes
WRAP-UP
GUIDED ■■ Respond to participants’ questions.
DISCUSSION: ■■ Provide participants with information on the first class session, including the
time of the class and location. Review the full course schedule and basic course
outline, including test dates.
■■ Provide participants who have passed the precourse evaluation with a copy
of the American Red Cross Lifeguarding Manual. All participants must have a
copy of the manual—digital or print—for use during the course.
■■ Instruct participants to complete the following assignments prior to the start of
the next in-person session.
cc If following the intensive outline, participants should read the Lifeguarding
Manual and complete all eLearning modules, including the conclusion which
contains the CPR/AED for Professional Rescuers and First Aid Final Written
Exam.
cc If following the extended outline, participants should complete the eLearning
Introduction and Module 1 and read the following chapter in the Lifeguarding
Manual:
●● Chapter 1: The Professional Lifeguard
Instructor’s Note: Each participant should have access to their own

manual throughout the course in either digital or print format. When
using a digital manual, a tablet or laptop should be used to ensure
proper viewing. (The manual should not be displayed on a cell phone.)
COUNSELING AFTER THE PRECOURSE SESSION

ACTIVITY: ■■ On an individual basis, after the precourse session has ended, advise each
participant who did not meet the prerequisites that:
cc Entry into the Red Cross Lifeguarding course is strictly limited to those who
meet the minimum age requirement and have successfully completed the
prerequisite swimming skills evaluation.
cc Failure to have attained the appropriate skill level could pose a safety threat to
themselves and to others in the class.
■■ Suggest appropriate developmental training opportunities and explain the specific
skills that the individual needs to improve to be eligible to take the Lifeguarding
course in the future, including Shallow Water Lifeguarding and Aquatic Attraction
Lifeguarding.

SKILL CHART AND SKILL ASSESSMENT TOOL
LIFEGUARDING AND SHALLOW WATER LIFEGUARDING COURSES AND

WATERFRONT AND WATERPARK SKILLS
Criteria Proficient Not Proficient
Continuous swim ■■ Swims designated distance ■■ Cannot swim designated
continuously using front crawl, distance continuously
breaststroke or a combination ■■ Swims on the back or side
of both without stopping to ■■ Stops to rest during a turn at
rest a wall
■■ Demonstrates comfort in deep ■■ Stops swimming, stands on
water the bottom or clings to rope,
■■ Swims with face in the water lane line or other support
and demonstrates breath ■■ Refuses to swim in deep water
control (slight hesitation
■■ Swims with head or face out of
during breathing acceptable)
the water
■■ Maintains body position that is
■■ Does not demonstrate breath
nearly horizontal to the surface
control or rhythmic breathing
■■ Uses above-water arm
■■ Body position is near vertical
recovery for the front crawl
■■ Uses underwater arm recovery
■■ Leg action contributes to
for the front crawl
forward momentum
■■ No leg action or leg action that
does not contribute to forward
momentum
Tread water ■■ Treads water for 2 minutes ■■ Unable to tread water for 2
■■ Body position is near vertical minutes
■■ Head remains above the ■■ Body position is near
surface horizontal—prone or supine
■■ Uses legs only ■■ Stands on the bottom or clings
to rope, lane line or other
support
■■ Swims rather than treads
■■ Mouth sinks below the surface
■■ Uses arms while treading
Timed event ■■ Completes the prerequisite ■■ Does not complete the
event within the designated prerequisite event within the
time designated time
■■ Submerges and retrieves a ■■ Does not submerge far enough
10-pound object to reach the 10-pound object
■■ Swims back to the side, ■■ Does not locate the 10-pound
holding the object in both object
hands while keeping the face ■■ Does not lift the 10-pound
at or near the surface of the object and return to the
water (Note: Shallow Water surface
Lifeguarding candidates can ■■ Returns to the side holding the
swim or walk) object in one hand
■■ Exits the water without using ■■ Returns to the side underwater
ladder or steps with the object and without
taking a breath
■■ Unable to exit the water
without ladder or steps

LIFEGUARDING AND SHALLOW WATER LIFEGUARDING COURSES AND
WATERFRONT AND WATERPARK SKILLS, CONTINUED
Waterfront Skill Module ■■ Swims 5 yards Walks along the bottom
■■
Only ■■ Submerges, swims and
■■ Does not submerge enough to
Underwater Swim Event retrieves three dive rings
reach the dive ring(s)
■■ Swims to the side with three
■■ Surfaces before retrieving all
dive rings three dive rings
■■ Does not retrieve all three dive
rings
■■ Does not swim back with three
dive rings
SKILL ASSESSMENT TOOL: AQUATIC ATTRACTION LIFEGUARDING
Water Competency ■■ Steps into water from side and ■■ Enters the water in an unsafe
Sequence totally submerges manner or does not totally
■■ Recovers to the surface submerge after entering the
without pushing off the bottom water
■■ Maintains position for 1 minute ■■ Does not recover to the
by treading or floating (or a surface or pushes off the
combination of the two) bottom to resurface
■■ Rotates one full turn and ■■ Is unable to maintain position
orients to the exit. for 1 full minute by treading or
■■ Levels off and swims on the floating (or a combination of
front or back for 25 yards the two)
■■ Exits the water without using a ■■ Does not rotate one full turn
ladder or steps ■■ Does not orient to the exit
■■ Is unable to level off or swim
on the front or back for 25
yards
■■ Is unable to exit the water
without using the ladder
Timed Event ■■ Completes the prerequisite ■■ Does not complete the
event within the designated prerequisite event within the
time designated time
■■ Submerges and retrieves a ■■ Does not submerge far enough
10-pound object to reach the 10-pound object
■■ Walks or swims on the back ■■ Does not locate the 10-pound
to the starting point, holding object
the object in both hands at the ■■ Does not lift the 10-pound
surface of the water object and return to the
■■ Exits the water without using surface
ladder or steps ■■ Returns to the side holding the
object in one hand
■■ Returns to the side holding the
object underwater
■■ Unable to exit the water
without using ladder or steps

LESSON 1
THE PROFESSIONAL LIFEGUARD
Lesson Length: 20 minutes

■■ Introduce participants to the Lifeguarding course.
■■ Guide the discussion on The Professional Lifeguard.
■■ Guide the discussion on legal considerations.
■■ Conduct the team building activity.
■■ Before attending the classroom session, participants should have completed the following
content areas via eLearning:
cc The Professional Lifeguard
cc Characteristics of a Professional Lifeguard
cc Responsibilities of a Professional Lifeguard
cc Legal Considerations
cc Continuation of Training
LESSON OBJECTIVES
■■ Describe the characteristics and responsibilities of a professional lifeguard.
■■ Explain how to fulfill the responsibilities of a professional lifeguard.
Define certain legal considerations and apply them to situations that might be encountered in
■■
lifeguarding.
■■ Describe ongoing training for lifeguards.
■■ Describe what it means to work as part of a lifeguard and safety team.
LESSON PREPARATION
■■ Set up equipment and have copies of the appropriate materials ready before the start of class.
■■ Be prepared to answer questions the participants may have about the review questions and the
eLearning module they completed.

INSTRUCTOR NOTES
■■ Remind participants to present the eLearning component completion certificates for the
eLearning Introduction and Module 1: The Professional Lifeguard. Instructors following the
intensive outline should verify that participants have completed all eLearning modules.
■■ The purpose of the team-building activity is to break the ice with participants, to get used to
working in close proximity, to communicate and to work together as a team.
TEACHING TIPS
■■ As you cover the topics of the course, refer to the review questions they may have completed,
as this may encourage them to complete those as the course progresses.
TOPIC: I NTRODUCTION TO THE COURSE Time: 5 minutes
WELCOME AND INTRODUCTION TO THE COURSE

GUIDED ■■ Welcome participants and introduce yourself, including your background in aquatics
DISCUSSION: and certification as an American Red Cross instructor. Have co-instructors and
aides introduce themselves, if applicable.
■■ Have participants introduce themselves.
■■ Review facility policies and procedures, and give locations of restrooms, water
REFERENCES: fountains, break areas and details unique to your facility. Also, point out where the
Course exits are located as well as where the automated external defibrillators (AEDs) are
Presentation: located.
Slides 3 ■■ Review the course schedule and basic outline, including blended learning
Participant’s expectations and written exams.
Manual: ■■ Explain to participants that the primary purpose of the Lifeguarding course is to learn
Chapter 1
the knowledge and skills needed to prevent and to respond to aquatic emergencies.
The course content and activities prepare participants to recognize and respond
quickly and effectively to emergencies and prevent drowning and injuries.
SHALLOW WATER LIFEGUARDING
■■ When conducting the Shallow Water Lifeguarding course, explain to participants
that the primary purpose of the course is to learn the knowledge and skills needed to
prevent and to respond to aquatic emergencies in shallow water up to 5 feet deep.
■■ Requirements for successful completion of the Blended course
include:
cc Attend and participate in all class sessions.
cc Complete all units of the eLearning component and provide proof
of completion to the instructor.
cc Demonstrate competency in all required skills and activities.
cc Demonstrate competency in all required final rescue skill scenarios.
cc Correctly answer at least 80 percent of the questions in each of the
two sections of the final written exam.
■■ Explain that upon successful completion of the Lifeguarding course, each
participant will receive an American Red Cross certificate for Lifeguarding/First
Aid/CPR/AED, which is valid for 2 years.

GUIDED SHALLOW WATER LIFEGUARDING
DISCUSSION: ■■ Explain that upon successful completion of the Shallow Water Lifeguarding
continued course, each participant will receive an American Red Cross certificate for
Shallow Water Lifeguarding (up to 5 feet)/First Aid/CPR/AED, which is valid for
2 years.
■■ Explain the ground rules for the course.
cc Participants must demonstrate a professional attitude and mature behavior,
including, but not limited to:
●● Being prepared for all class activities, including appropriate
swimwear for all in-water skill sessions.
●● Completing reading assignments.
●● Completing all eLearning units.
●● Behaving appropriately during activities.
●● Making an effort to improve skills during practice sessions.
●● Treating others with respect.
●● Following all pool safety rules and any additional safety

precautions as explained throughout the course.
●● Demonstrating respect for the facility and equipment used in the course.
cc Ask participants to turn off or silence cell phones and refrain from using
electronic devices during all class sessions, with the exception of accessing
digital course materials.
cc Explain that participants should secure any items of value or avoid bringing
them to class if possible.
cc When following the extended outline, explain that participants must complete
the assigned eLearning modules before each session and bring their proof of
completion to each session. Proof of completion may be printed or displayed
electronically on a laptop or mobile device.

TOPIC: B EING PART OF A TEAM Time: 10 minutes
TEAM-BUILDING ACTIVITY
ACTIVITY:
Instructor’s Note: Choose just one of the following activities.
You do not need to have the class complete both. The purpose
of the team-building activity is to break the ice with participants,
to get participants used to working together in close proximity,
REFERENCES: communicating and working together as a team.
Course
Presentation:
Slides 5 ■■ Superlatives—This activity requires participants to work together and sort
themselves into order (in a line from left to right) based on prompts from the
Participant’s
Manual: instructor.
Chapter 1 cc Line participants up so they are standing shoulder to shoulder.
cc Begin by giving participants prompts to reorder themselves in the line, such
as: “Sort yourselves from youngest on the left to oldest on the right.”
cc Inform participants that they should talk amongst themselves to uncover the
information about each other they’ll need to complete the ordering activity.
cc After a series of simple prompts, begin giving participants more difficult
prompts that will require them to learn more about each other, such as:
“Sort yourselves from least experience to most experienced in terms of
lifeguarding.”
cc Stop the activity after about 8 minutes.
■■ Human Knot
cc Divide participants into teams of six to eight people. Have each team move to
a location that allows them to stand shoulder to shoulder in a small circle.
cc Instruct members of each team to form a human pretzel by having each
person extend their left hand across the circle and grasp the left hand of
someone else not directly next to them. Then have each person extend their
right hand across the circle and grasp the right hand of another, different
person.
cc Inform the teams that their task is to unravel their interlocking arms without
letting go of anyone’s hands and without causing injury. If group members
break the chain, they must repair the break the way it was or start over.
cc Stop the activity after about 8 minutes if the group is unsuccessful at making
the circle without breaking the chain of hands. It is sometimes impossible to
get to a single circle.

GUIDED ■■ Ask participants the following:
DISCUSSION: cc How did it feel to be successful or unsuccessful?
cc What strategy did your team use to complete the task?
cc Who were the leaders in this activity?
cc Did the team reach consensus on a plan of action or take action
REFERENCES: without a plan?

Course cc How well did your team communicate during this activity?
Presentation: cc If you could do it again, what would you change?
Slides 6-11 ■■ Just as in the activity, the lifeguard team must communicate and work
Participant’s together effectively when responding to emergencies.
Manual:
Chapter 1
■■ Effective communication, trust, mutual respect, commitment and
cooperation are crucial elements for working effectively as a team.
■■ Ask participants: In your job as a lifeguard, aside from being a team
player while responding to emergencies, what can you do as an
individual to have a positive effect on the team?
Answers: Responses should include the following:
cc Arriving to work on time
cc Rotating stations on time
cc Attending in-service trainings
cc Enforcing safety rules in a consistent manner
cc Communicating clearly while treating others with respect
cc Being prepared by maintaining knowledge, skills and physical fitness
cc Completing secondary responsibilities in a timely and acceptable fashion
■■ As lifeguards, you should be given an Emergency Action Plan (EAP)
that guides the actions of lifeguards and other team members in
emergencies. The EAP describes what needs to be done and who
does it in the event of an emergency. EAPs are discussed in more
detail later in the course.
■■ The lifeguard team is part of the broader facility safety team.
cc The safety team includes management and maintenance staff who
provide assistance in maintaining a safe environment and providing
emergency care.
cc Local emergency response personnel also are part of the
safety team.
ASSIGNMENT
ACTIVITY: ■■ When following the extended outline, instruct participants to complete the
following assignments prior to the start of the next in-person session.
cc Complete eLearning Module 2: Facility Safety.
cc Read Chapter 2: Facility Safety in the Lifeguarding Manual.
REFERENCES:
Course
Presentation:
Slides 12

LESSON 2
FACILITY SAFETY AND
PATRON SURVEILLANCE
Lesson Length: 2 hours, 25 minutes

■■ Conduct the in-water skill session for entries and approaches.
■■ Conduct the skill drill for entries and approaches.
cc Facility Safety
cc The Drowning Process
cc Effective Surveillance—Zones of Surveillance Responsibility
cc Effective Surveillance—Victim Recognition and Scanning
cc Entries and Approaches
LESSON OBJECTIVES
■■ Describe the role lifeguards play in ensuring facility safety.
■■ Identify how to ensure the safety of patrons when weather conditions create safety concerns.
■■ Explain the reasons for common rules and regulations at aquatic facilities.
■■ Describe the role that facility management plays in facility safety and the lifeguarding
operational benchmarks for facilities.
■■ Describe the drowning process.
■■ Identify the behaviors of a swimmer, distressed swimmer and an active and passive victim.
■■ Identify and define elements of effective surveillance.
■■ Explain proper scanning techniques and identify tactics to overcome scanning challenges.
■■ Identify various types of zones of surveillance.
■■ Demonstrate how to safely and effectively enter the water and approach a victim.
■■ Explain patron surveillance techniques for facilities with special attractions.
■■ Explain and demonstrate lifeguard rotations.
■■ Demonstrate how to perform effective surveillance including scanning, searching, victim
recognition and lifeguard rotations.
■■ Explain various types of drills that test lifeguard zones, recognition and response.

■■ 10-pound object (a diving brick or weight—one for every five participants)
■■ Timing device, such as a stopwatch or smartphone with a stopwatch feature (one per
instructor)
LESSON PREPARATION
■■ To save time, have all equipment and supplies prepared and available ahead of time.
■■ Have copies of the appropriate materials ready before the start of class.
■■ Be prepared to answer questions the participants may have about the eLearning content they
completed.
INSTRUCTOR NOTES
■■ When following the extended outline, remind participants to present the eLearning component
completion certificates they received when they completed eLearning Module 2: Facility Safety.
TEACHING TIPS
■■ You must be able to observe each participant’s performance of the skill and provide global and
individual feedback during skill practice to correct common mistakes or commend correct skill
practice.
■■ Set up groups so that you can observe each group, but allow enough room for the groups to
conduct the skills and scenarios without disrupting each other or causing injury.

TOPIC: FACILITY
SAFETY AND THE Time: 5 minutes
DROWNING PROCESS
THE UNPROFESSIONAL LIFEGUARD AND NOT ON YOUR WATCH
GUIDED ■■ Briefly discuss the videos “The Unprofessional Lifeguard” and “Not on Your Watch”
DISCUSSION: and ask participants if they have any questions or reflections.
REFERENCES:
Participant’s
Manual:
Chapter 2, 3
TOPIC: I N-WATER SKILL SESSION: ENTRIES Time: 40 minutes

AND APPROACHES
SKILL PRACTICE
SKILL ■■ Ask participants: What questions do you have about the “Entries and
PRACTICE: Approaches” videos?
■■ Explain to participants that during the water rescue skill sessions you will
demonstrate skills that they saw in the videos included in the eLearning module
and guide them through practice.
■■ For each skill, be sure to review key points from the text and video, including
REFERENCES: instructions on how to perform each skill and reminders about when each entry
or approach is appropriate.
REFERENCES: ■■ Explain that every rescue should begin by activating the EAP. Participants should
Course simulate this during each practice session.
Presentation: ■■ Explain that the signals used to activate the EAP may vary among facilities.
Slides 15
Define the method that will be used in skill sessions, including the following:
Participant’s cc Announce the activation of the EAP with a loud signal either mimicking a
Manual:
Chapter 6 whistle or making a verbal announcement.
cc Point to the victim that is in need of help.
Lead them through the following skills using a rescue tube:
■■
cc Slide-In Entry and Walking Approach
●● Especially useful in shallow water, crowded pools or when a victim with

a head, neck or spinal injury is close to the side of the pool.
cc Slide-In Entry and Swimming Approach
●● Especially useful in shallow water, crowded pools or when a victim with

a head, neck or spinal injury is close to the side of the pool.
cc Stride Jump and Swimming Approach
●● When you are less than 3 feet above the water and the water is at least
5 feet deep.
cc Compact Jump and Swimming Approach
●● When you are more than 3 feet above the water and the water is at least
5 feet deep.
●● Jump from the deck into the water.

SKILL SHALLOW WATER LIFEGUARDING
PRACTICE: ■■ When conducting the Shallow Water Lifeguarding course, omit the stride jump
continued and swimming approach. The compact jump should be performed when the
lifeguard is 3 feet or less above the water.
■■ Remind participants that if the tube slips out or if they need to swim a longer
distance, let the tube trail behind. They should reposition the tube as appropriate
before making contact with the victim.
■■ Observe each participant’s performance of the skill and provide global and
individual feedback during skill practice to correct common mistakes or
commend correct skill practice.
■■ Participants should practice the skills several times. Time permitting, participants
should practice the skills until they are able to meet performance criteria.
Participants who cannot meet the performance criteria should be counseled to
practice outside of class times if possible.
■■ Observe each participant’s performance of the skill and provide corrective
feedback.
SKILL DRILL: ENTRIES AND APPROACHES
SKILL DRILL—
ENTRIES AND Instructor’s Note: The purpose of this activity is for participants
APPROACHES: to use critical thinking to decide which entry to use based on the
scenario and also to develop speed, endurance and experience
when performing approaches with a rescue tube.
■■ Explain to participants that they now are going to practice the entry and
REFERENCES: approach skills to make decisions as to when it is appropriate to use the
Participant’s different entries and approaches and build fitness.
Manual:
Chapter 6 ■■ Keep participants moving throughout these activities to develop conditioning for
speed and endurance:
cc Have participants simulate activating the EAP, perform a designated entry
and then swim an approach stroke with a rescue tube as fast as they can for
a significant distance, 25 yards if possible, climb out without using the ladder
and walk quickly back to the starting point. Repeat until participants have
done this several times, sometimes swimming the approach stroke with the
rescue tube under their armpits and sometimes with the rescue tube trailing
behind.
cc Continue to follow the skill drill using the same pattern but give participants a
scenario and let them decide what entry to use, such as:
●● The water is murky and they cannot see the bottom: Slide-In Entry.
●● They are guarding on the deck and the water is 4-feet deep:
Compact Jump.
●● The pool is crowded and swimmers are directly in front of them:
Slide-In Entry.
●● They are in an elevated lifeguard station that is 4 feet above the level of the
water and the water is 7-feet deep: Compact Jump.
●● They are in an elevated guard chair that is not suitable for a jump so they
must climb down to enter the water. The chair could be situated in a
shallow water area or not secured adequately to allow the lifeguard to jump
from it. Simulate stepping down from the stand and perform a Compact
Jump or Slide-In Entry.
●● They suspect a spinal injury close to the edge of the pool: Slide-In Entry.
●● They are guarding a deep water area on the deck and suspect a spinal
injury at the far side of the pool: Compact Jump, Stride Jump or Slide-In
Entry.

ASSIGNMENT
following assignments prior to the next in-person session.
cc Complete eLearning Module 3: Injury Prevention.
cc Read the following chapters in the Lifeguarding Manual:
●● Chapter 3, Surveillance and Recognition

REFERENCES:
Course ●● Chapter 4, Injury Prevention
Presentation:
Slides 16
SKILL CHARTS AND ASSESSMENT TOOLS

In addition to performing the steps listed in the skill chart in the correct order, participants must meet the
criteria listed at the proficient level to be checked off for this skill.
ENTRIES
SKILL CHART: SLIDE-IN ENTRY
1. Sit down on the edge facing the water. Place the rescue tube next to you or in the water.
2. Lower your body into the water feet-first.
3. Retrieve the rescue tube.
4. Place the rescue tube across your chest with the tube under your armpits, focus on the
victim and begin the approach.
SKILL CHART: COMPACT JUMP
1. Squeeze the rescue tube high against your chest with the tube under your armpits.
2. Hold the excess line to keep it from getting caught on the lifeguard chair or other equipment when
jumping into the water.
3. Jump out and away from the lifeguard chair, pool deck or pier. In a wave pool, time the jump to land
on the crest (top) of a wave.
4. Bend your knees and keep your feet together and flat to absorb the shock if you hit the bottom. Do
not point your toes or keep your legs straight or stiff.
5. Let the buoyancy of the rescue tube bring you back to the surface.
6. Focus on the victim when surfacing and begin the approach.
SKILL CHART: STRIDE JUMP
1. Squeeze the rescue tube high against your chest with the tubeunder your armpits.
2. Hold the excess line to keep the line from getting caught on something when jumping into the
water.
3. Leap into the water with one leg forward and the other leg back.
4. Lean slightly forward, with your chest ahead of your hips, and focus on the victim when you enter
the water.
5. Squeeze or scissor your legs together right after they make contact with the water for upward
thrust.
6. Focus on the victim and begin the approach.

SKILL ASSESSMENT TOOL: ENTRIES
Equipment is properly ■■ Control of the rescue tube ■■ Contact with the rescue tube
positioned for the appropriate maintained not maintained
entry ■■ Tube held securely to the chest ■■ Tube not held securely to the
for the compact jump and stride chest for the compact jump
jump and stride jump
■■ Excess line held to keep it from ■■ Excess line not held
getting caught on the lifeguard
stand or other equipment
Appropriate entry is selected ■■ Assumes a sturdy posture and ■■ Entry causes a safety hazard
for the situation stable footing
Focus on the victim is ■■ Upon entering (or resurfacing ■■ Fails to look toward the victim
maintained after a compact jump), focus or site where the victim was
on the victim or the site where last seen
the victim was last seen is
maintained
RESCUE APPROACHES
SKILL CHART: WALKING APPROACH
1. Walk to the victim.
2. Hold the rescue tube at your side and walk quickly toward the victim.
3. If necessary, position the tube in front of you before contacting the victim.
SKILL CHART: SWIMMING APPROACH
1. Swim to the victim using a modified front crawl or breaststroke.
2. Keep the rescue tube under your armpits or torso and swim toward the victim with your head up,
keeping the rescue tube in control at all times.
3. For longer distances, or if the rescue tube slips out from under your arms or torso while you are
swimming, let the tube trail behind.
4. If necessary, reposition the rescue tube in front of you before contacting the victim.
SKILL ASSESSMENT TOOL: APPROACHES
Approaches victim safely and ■■ Effective propulsion used for ■■ No effective propulsion
quickly safe approach ■■ Approach causes a safety
hazard
Focus on the victim is ■■ Focus on the victim or the site ■■ Fails to look toward the
maintained where the victim was last seen victim or site where the victim
is maintained was last seen
Equipment is properly ■■ Control of rescue tube is ■■ Fails to maintain contact with
positioned for the appropriate maintained during approach the rescue tube
approach ■■ Tube is strapped on during ■■ Does not strap on tube
approach during approach
■■ Tube remains in position or is ■■ Tube is not in position for
repositioned as needed before the selected rescue before
contact with victim contact with victim

LESSON 3
INJURY PREVENTION
Lesson Length: 1 hour, 10 minutes

■■ Complete the skill practice for Victim Recognition and Lifeguard Rotations.
■■ Conduct the Victim School activity.
■■ Conduct the Effective Scanning and Lifeguard Rotations activity.
■■ Conduct the Round Robin Brick Drill, Rescue Tube Relay and Ask Drill activities.
cc Injury Prevention Strategies
cc Guarding a Variety of Activities
cc Guarding Special Attractions
cc Guarding for Organized Recreational Swim Groups
LESSON OBJECTIVES
After completing this lesson, participants will be able to:
■■ Explain how communication with patrons plays a role in preventing injuries.
■■ Explain patron surveillance techniques for organized groups.

Rescue tubes (one for every two participants)
■■
LESSON PREPARATION
■■ Have copies of the appropriate materials ready before the start of the class.
■■ Be prepared to answer questions the participants may have about the review questions they
completed.

INSTRUCTOR NOTES
completion certificates they received when they completed eLearning Module 3: Injury
Prevention.
■■ The purpose of the Victim School activity is for participants to learn and practice how each of
the victim types should act during the rescues throughout the course, so they are getting the
most realistic practice being a rescuer as the course progresses (i.e., the victim does not help
the rescuer). It will also help them identify victim types throughout the course.
■■ A drowning victim who is active and struggling may be in a horizontal face-down position during
the struggle because they are unable to lift their face out of the water. This may be particularly
likely with a younger swimmer, such as a toddler.
■■ The purpose of the EAP activity is for participants to gain experience scanning, recognizing
victims, activating an EAP and performing lifeguard rotations.
■■ The purpose of the Round Robin Brick drill is for participants to build endurance and skill in
treading water.
■■ The purpose of the Rescue Tube Relay drill is to build endurance, to gain additional practice
with entries and approaches and experience swimming quickly with the rescue tube. If a relay
is not practical, you can switch this activity to sprints.
■■ The purpose of the ask drill activity is to help lifeguards understand the ask drill, a drill
commonly used by lifeguard managers to identify what lifeguards can and cannot see from
each station. The intent of this activity is not to practice victim recognition, but to identify what
the lifeguard can actually see at the top, middle or bottom of the water from their station.
■■ For realistic simulation and practice, when possible, conduct the ask drill activity when the
facility is open to the public and other activities such as recreational swim, swim lessons or lap
swim are happening. Ensure that you communicate the drill with the lifeguard management and
the lifeguards on duty, so that the lifeguards are aware and do not mistake the drill for an actual
emergency. Monitor the situation and be prepared to intervene if a patron is alarmed.
■■ There’s no “wrong” answer. If the participants do not see a victim or object, they have identified
a challenge for lifeguards at that station. It is possible that they did not identify the victim or
object because of a scanning challenge such as a blind spot, glare, water movement, heavy
patron loads, etc.
■■ When conducting the Victim School activity, remind participants that a drowning victim who is
active and struggling may be in a horizontal face-down position during the struggle because
they are unable to lift their face out of the water. This may be particularly likely with a younger
swimmer, such as a toddler.
■■ You can conduct the Ask Drill activity when the facility is open to the public and other
activities such as recreational swim, swim lessons or lap swim are happening. Ensure that you
communicate the drill with the lifeguard management and the lifeguards on duty so that the
lifeguards are aware and do not mistake the drill for an actual emergency.
When conducting the Ask Drill activity, there is no “wrong” answer. If the participants don’t see
■■
a victim or object, they have identified a challenge for lifeguards at that station. It is possible
that they did not identify the victim or object because of a scanning challenge, such as a blind
spot, glare, water movement, heavy patron loads, etc.
■■ Plan to assign each participant a number and record it with their name to avoid calling the
number of one of those playing the lifeguard role for the surveillance activity.
TEACHING TIPS
practice.

TOPIC: INJURY PREVENTION Time: 5 minutes
INJURY PREVENTION
GUIDED ■■ Briefly discuss the video “Injury Prevention” and ask participants if they have any
DISCUSSION: questions or reflections.
REFERENCES:
Participant’s
Manual:
Chapter 4
TOPIC: I N-WATER SKILL SESSION: Time: 35 minutes

VICTIM RECOGNITION AND
LIFEGUARD ROTATIONS
VICTIM SCHOOL
ACTIVITY:
Instructor’s Note: The purpose of this activity is for participants
to learn and practice how each of the victim types should act
during the rescues throughout the course, so they are getting the
most realistic practice being a rescuer as the course progresses
(i.e., the victim does not help the rescuer). It will also help them
REFERENCES: identify victim types throughout the course.
Course
Presentation: ■■ Explain to participants that they are going to participate in an activity to help them
Slides 18 understand the different types of victims they will encounter during this course.
■■ The purpose of this activity is to help participants understand how to play the
role of a victim.
■■ Throughout the course, participants will be required to act as both rescuer and
victim to gain realistic experience practicing rescues.
■■ Lead participants through an in-water practice session of each of the following
victim behaviors:
cc Swimmers in Distress:
cc Able to keep your face out of the water
●● Able to call for help
●● Able to wave for help
cc Drowning Victim–Active and Struggling at the Surface:

●● Ineffective kick
●● Head leaning back
●● Arms either out to the side or to the front, pressing down on the
water (like they are trying to climb a ladder underwater;
arms not flailing above their head)
●● Struggling to keep their mouth above water to breathe
cc Drowning Victim–Active and Struggling–Submerged:

●● Climbing a ladder under water, fighting to get to the surface
●● Staring at the surface of the water, unable to make progress towards

the surface

Instructor’s Note: A drowning victim who is active and struggling
may be in a horizontal face-down position during the struggle
because they are unable to lift their face out of the water. This may
continued be particularly likely with a younger swimmer, such as a toddler.
cc Drowning Victim Who is Passive and Not Struggling–Face-Down:

●● Limp, no movement
●● Floating at the surface
●● Horizontal or vertical
cc Drowning Victim Who is Passive and Not Struggling–Submerged:

●● Limp, no movement
●● Underwater, at the bottom or sinking towards the bottom
■■ Horizontal or vertical. Explain to participants that when they are acting as a

victim in class, it’s important to be realistic to allow for properly simulated
emergency scenarios throughout the rescue.
■■ For example, when acting as a passive victim and being rescued by another
participant, they must remain limp and unresponsive until the instructor prompts.
■■ Explain that assisting the rescuing lifeguard by swimming or kicking is
not appropriate for passive drowning victims. Doing so will prevent other
lifeguarding course participants from gaining realistic practice in this important
lifesaving skill.
EFFECTIVE SCANNING AND LIFEGUARD ROTATIONS

ACTIVITY:
Instructor’s Note: The purpose of this activity is for participants
to gain experience scanning, recognizing victims, activating an
EAP and performing lifeguard rotations.
REFERENCES: ■■ Explain to participants that they are going to participate in an activity to

Course experience effective scanning and lifeguard rotations.
Presentation: ■■ Two participants will be positioned on deck as lifeguards, equipped with rescue
Slides 19
tubes and hip packs. The remaining participants will be in the water as if it were
a recreational swim time.
■■ Assign each participant a number and record it with their name to avoid calling
the number of one of those playing the lifeguard role. When their number is
called, they will know it is their turn to play the role of a distressed swimmer, an
active victim or a passive victim. The victim should not react immediately but
should allow the lifeguards some time to scan the pool before presenting them
with the challenge of victim recognition.
■■ Assign zones of coverage for the lifeguards. When a victim is recognized, the
lifeguard should activate (or simulate) the EAP, point to the victim and state
what type of victim they observe.
■■ Place an extra rescue tube and hip pack on the deck for the incoming lifeguard.
Explain that the participant who was the victim will exit the water, put on a
rescue tube and hip pack and rotate into the position of one of the lifeguards.
The lifeguard who is being replaced will rotate to the position of the other
lifeguard; afterward, they will place the rescue tube and hip pack on the deck
and enter the water to join the recreational swim group. Follow the same pattern
of rotation throughout the activity.

■■ Remind participants that they need to follow rotation procedures that maintain
patron surveillance.
cc Each lifeguard should carry their own rescue tube during the rotation.
continued cc The incoming lifeguard should be aware of the patrons and activity level of
the zone and begin scanning while walking toward the station, checking all
areas of the water from the surface to the bottom.
cc The outgoing lifeguard should inform the incoming lifeguard of any situations
that need special attention. The exchange of information should be brief and
patron surveillance must be maintained throughout the entire rotation.
cc Once in position, with the rescue tube strapped on, the incoming lifeguard
makes any adjustments needed, such as removing shoes or adjusting an
umbrella, before confirming to the outgoing lifeguard that they “own the
zone.” The outgoing lifeguard should continue scanning as they are walking
toward the next station.
cc Begin the activity with the lifeguards that have been assigned to be on deck.
Call out a number that has been assigned to one of the participants who is in
the water.
cc Provide guidance as needed for both victim recognition and for the
lifeguard rotation.
cc Continue the activity until everyone has had the opportunity to play the role of
a lifeguard.
TOPIC: PUTTING IT ALL TOGETHER Time: 35 minutes
ROUND ROBIN BRICK DRILL

ACTIVITY:
Instructor’s Note: The purpose of this drill is for participants to
build endurance and skill in treading water.
■■ Gather participants and explain they will be participating in three activities to

REFERENCES: challenge their physical fitness, skill and test a typical zone of surveillance.
Course
Presentation: ■■ Have participants form a circle in deep water and begin treading.
Slides 20 ■■ Hand one participant a brick and have them tread water while holding the brick
at the surface of the water with both hands for 20 seconds. At your signal,
have participants pass it to the person on their right. Participants who are not
currently supporting the brick will alternate between treading water by kicking
only, then using their arms and legs each time you signal.
■■ Anyone who drops the brick must retrieve it.
■■ Continue this activity for about 7 to 10 minutes.
■■ You can vary this activity by adding additional items to the circle, such as
another brick and a tennis ball.

■■ For the Shallow Water Lifeguarding course, place three bricks on the bottom of
the shallow end of the pool, starting at the edge of the pool; there should be 5
feet between each brick.
■■ At your signal, have participants swim under water to the first brick, pick up the
brick and stand up, bringing the brick to the surface of the water. After placing
the brick back on the bottom of the pool, have participants swim to the next
brick and repeat the drill.
■■ Continue this activity until every participant has retrieved all three bricks two times.

RESCUE TUBE RELAY
ACTIVITY:
Instructor’s Note: The purpose of this drill is to build endurance,
to gain additional practice with entries and approaches and
experience swimming quickly with the rescue tube. If a relay is
not practical, you can switch this activity to sprints.
REFERENCES:
Course ■■ Explain to participants that this is a swimming relay activity to practice entries
Presentation: and approach strokes combined with speed.
Slides 20 ■■ Divide the group into two or more teams with an equal number of participants.
■■ Each team member, wearing a hip pack, must either do a stride jump or
compact jump into the water and swim to the other side, using a modified front
crawl or breaststroke while keeping the rescue tube under their armpits.

■■ For the Shallow Water Lifeguarding course, participants should use the
compact jump to enter the water.
■■ When each team member reaches the other end of the pool, they should hand
off the rescue tube and hip pack to the next person in line. The next person in
line performs a stride jump or compact jump into the water and swims with the
rescue tube back to the starting point.
■■ Continue this process until each team member has participated, or continue for
about 7 to 10 minutes.
■■ You can vary this activity by changing the type of entry, approach stroke or
letting the tube trail behind.

ASK DRILL
ACTIVITY:
Instructor’s Note: The purpose of this activity is to help
lifeguards understand the ask drill, a drill commonly used by
lifeguard managers to identify what lifeguards can and cannot see
from each station. The intent of this activity is not to practice victim
REFERENCES: recognition, but to identify what the lifeguard can actually see at
Course the top, middle or bottom of the water from their station.
Presentation:
Slides 20
For realistic simulation and practice, when possible, conduct
this activity when the facility is open to the public and other
activities such as recreational swim, swim lessons or lap swim
are happening. Ensure that you communicate the drill with the
lifeguard management and the lifeguards on duty, so that the
lifeguards are aware and do not mistake the drill for an actual
emergency. Monitor the situation and be prepared to intervene if a
patron is alarmed.
■■ Divide participants into two teams: one lifeguard team and one patron team.
cc The lifeguard team should wait in a different room or be unable to see while
the instructor places the objects and “victims”.
■■ Place an object, such as a manikin, silhouette, a live “victim” (other course
participant) or a sinkable object, in various locations.
■■ Have participants take turns acting as the lifeguard stationed at different
stations throughout the pool area. These should include stations used by the
lifeguards at that facility, including elevated stations, ground-level stations and
roving stations.
■■ Ask the lifeguards:
cc Can you see the object(s)?
cc Which object(s) would cause you to respond and why?
■■ If a lifeguard does not identify an object or victim, ask them what could be done
reduce or eliminate the scanning challenges at that station.
Instructor’s Note: There’s no “wrong” answer. If the participants

do not see a victim or object, they have identified a challenge for
lifeguards at that station. It is possible that they did not identify the
victim or object because of a scanning challenge such as a blind
spot, glare, water movement, heavy patron loads, etc.
ASSIGNMENT
cc Complete eLearning Module 4: Water Rescue Skills
●● Chapter 5, Emergency Action Plans
REFERENCES:
Course ●● Chapter 6, Water Rescue Skills
Presentation:
Slides 21

LESSON 4
WATER RESCUE SKILLS

■■ Discuss all points in the topic Water Rescue Skills—Submerged Victim Rescues.
■■ Conduct the skill practice for rescues at or near the surface.
■■ Complete the skill drills for Passive Victim Extrication (a four-part skill drill).
■■ Conduct the EAP activity.
■■ Conduct the skill practice for submerged victim rescues and extrication.
cc Emergency Action Plans
cc Water Rescue Skills—Rescues at or Near the Surface
cc Water Rescue Skills—Submerged Victim Rescues
cc Extrications
LESSON OBJECTIVES
■■ Guide the discussion on Emergency Action Plans.
■■ Complete the Putting It All Together—EAP for Active Victim or Distressed Swimmer.
■■ Demonstrate how to safely and effectively rescue a submerged victim in shallow or deep water.
■■ Demonstrate how to safely and effectively perform feet-first and head-first surface dives.
■■ Demonstrate how to safely and effectively extricate a passive victim from the water using a
backboard.
■■ Demonstrate how to put on gloves in a wet environment.

■■ Backboard (one for every three participants)
■■ Timing device, such as a stop watch or smartphone with a stop watch feature
LESSON PREPARATION
■■ Be prepared to answer questions participants may have about the review questions they
completed.

INSTRUCTOR NOTES
completion certificates they received when they completed eLearning Module 4: Water Rescue
Skills.
■■ To help ensure participant comfort and safety when practicing submerged victim rescues:
cc Instruct participants that if they experience difficulty when playing the role of a victim, they
should signal “let go” to the lifeguard by a predetermined safety signal, such as a tap or
gentle pinch.
cc Explain that ear and sinus squeeze can be uncomfortable; for those with congestion, it can
be painful or even cause damage to the ear. In this course, when practicing rescues of
submerged victims, participants are required only to go to a depth of 7 to 10 feet. However,
when hired to work at a facility with deeper water, they would be expected to be able to go
all the way to the bottom.
■■ Explain to participants that swim goggles may not be used for rescues of submerged victims
since they have no mechanism for pressure relief, which could result in injury to the eyes when
swimming in deeper water. They will be expected to open their eyes under water to perform
rescues.
TEACHING TIPS
practice.
■■ When conducting the skill drill for active and passive victim rescues, ensure the participants are
challenged by keeping them all moving and rotating to gain experience with a variety of victims
(other participants in the class).

TOPIC: IN-WATER SKILL SESSION— Time: 1 hour, 25 minutes
RESCUE SKILLS, PART 1
WATER RESCUE SKILLS—RESCUES AT OR NEAR THE SURFACE
SKILL ■■ Ask participants: What questions do you have about the "Rescues at or
PRACTICE: Near the Surface" video?
■■ Ask participants: What are the different rescue skills that lifeguards use to
rescue a victim at or near the surface of the water?
cc Reaching Assist
REFERENCES:
Course cc Simple Assist
Presentation: cc Active Victim Front Rescue
Slides 24 cc Active Victim Rear Rescue
Participant’s cc Passive Victim Front Rescue
Manual:
Chapter 6 cc Passive Victim Rear Rescue
■■ Explain to participants that during water rescue skill sessions you will
demonstrate skills that they saw in the videos included in the eLearning module
■■ Pair up participants and explain that they will take turns as a victim and rescuer
for each skill. For the multiple victim rescue, reassign participants into groups of
three.
■■ For each skill, organize participants so that they can clearly see and hear. Be
sure to provide any instructions related to their position in the water or how they
should behave as victims.
■■ Lead them through the following skills for victims at or near the surface:
cc Reaching Assist From the Deck
●● Lifeguards: on the edge of the deck
●● Victims: about 3 feet from the edge of the pool; distressed swimmer
cc Simple Assist
●● Lifeguards: standing in shallow water
●● Victims: standing in shallow water; losing balance
cc Active Victim Front Rescue

●● Victims: at least 10 yards from the edge of the pool

facing the lifeguard; struggling in deep water
●● Victims: at least 10 yards from the edge of the pool facing

away from the lifeguard; struggling in deep water

SKILL {{ Passive Victim Front Rescue
PRACTICE: ●● Lifeguards: on the edge of the deck
continued
●● Victims: in deep water, passive

●● Victims: in deep water, passive

●● Lifeguards: in the water
●● Victims: two victims per rescuer in deep water; when

playing the role of the victims they should face each other,
one victim holding securely to the other victim
individual feedback to correct common mistakes or commend correct skill
practice.

■■ For the Shallow Water Lifeguarding course, practice the simple assist and
reaching as noted above.
■■ For the Active Victim Front Rescue, Active Victim Rear Rescue and Multiple
Victim Rescue, practice in water up to 5 feet deep.
■■ For the Passive Victim Front and Rear Rescue, the victim should be at or near
the surface of the water.

SKILL DRILL—
ACTIVE & Instructor’s Note: The purpose of this skill drill is to keep lifeguard
PASSIVE participants rotating and practicing rescues for a variety of different
VICTIM victim types.
RESCUES:
■■ Explain to participants that they are going to participate in an activity
to practice recognizing a victim, activating the EAP, entering the water,
approaching a victim, performing a rescue and returning the victim safely to
REFERENCES: the side of the pool. This is designed to allow participants to practice rescuing
Participant’s a variety of victims in rapid succession.
Manual: ■■ Divide the class in half and assign one group as lifeguards and the other
Chapter 6
group as victims. Line up lifeguards stationed on the deck, one per victim in
the water:
VICTIMS X X X X X
LIFEGUARDS O O O O O
■■ Explain that when you say, “Go!” all victims and lifeguards will go at the same
time:
cc The victims will simulate an active victim facing the lifeguard.
cc The lifeguards will simulate the EAP signal, enter the water, rescue the
victim and return the victim to a point of safety at the wall where the rescuer
started the rescue.
cc Lifeguards will exit the water and the victims will return to their same spot in
the water to be victims again.
■■ Once out of the water and standing in front of their victims again, have each
lifeguard move one spot down so they are stationed in front of the next victim in
line. Have the last rescuer in line move to the first position so that each lifeguard
has a new victim in front of them. On your instruction to go, lifeguards will
repeat the Front Active Victim Rescue with the new victim.
■■ Continue until all lifeguards have rotated down the line to rescue each victim
and they are back in front of the victim they started with.
■■ Repeat the drill with the victim facing away from the rescuer.
■■ Repeat this drill after each participant has had the opportunity to rescue active
drowning victims.
cc Repeat drill for Passive Victim Front Rescue.
cc Repeat drill for Passive Victim Rear Rescue.
■■ Examples of common errors to point out include:
{{ Active Victim Front Rescue: not keeping straight arms throughout, pushing
the victim onto their back, not having the victim lean forward on tube to
stay up
{{ Active Victim Rear Rescue: not communicating with the victim after making
contact, trying to put the active victim into a vertical position, trying to put
them completely on their back

SKILL DRILL: {{ Passive Victim Front Rescue: grasping the victim’s arm in the incorrect place
continued (topside instead of underside), unable to easily turn the victim face-up by
pulling and twisting the arm, not pushing the tube (with a straight arm) under
the victim’s back during the turn, letting go of one arm before in position to
tow, victim’s head not in an open airway position during the tow, not reaching
over the tube for the tow, not hooking the towing arm tight during the tow
{{ Passive Victim Rear Rescue: victim’s head not in an open airway position
during the tow, not reaching over the tube for the tow, not hooking the towing
arm tight during the tow
{{ Multiple Victim Rescue: not supporting the victim’s head
TOPIC: PUTTING IT ALL TOGETHER Time: 35 minutes
EAP ACTIVITY
ACTIVITY:
Instructor's Note: The purpose of this activity is for participants to
gain experience in an EAP as the rescuer and assisting responder, and
to use critical thinking in assessing how the EAP went.
REFERENCES: ■■ Ask participants: What questions do you have about the "Emergency
Course Action Plans" video?
Presentation: ■■ Ask participants: What is the purpose of an EAP?
Slides 26 Answer: The purpose of an EAP is to describe everyone’s responsibility in an
Participant’s emergency.
Manual: ■■ Explain to participants that they are going to participate in an activity to practice
Chapter 5
an EAP for an active victim or distressed swimmer.
■■ Assign one lifeguard who is performing patron surveillance and one back-up
lifeguard who is not on surveillance duty. Assign the zone and have the lifeguard
go to the lifeguard station, and have the back-up lifeguard go to an area on the
deck where they can see the lifeguard station.
■■ Explain to participants that upon recognizing a victim, the lifeguard will:
cc Activate the EAP.
cc Enter the water using the appropriate entry.
cc Perform the appropriate rescue.
cc Bring the victim to a point of safety at the side of the pool.
■■ Explain to participants that when the EAP signal is activated, the back-up
lifeguard will get a rescue tube, go to the lifeguard station and assume
coverage of the zone.
■■ Gather the rest of the group so that the lifeguards cannot hear. Assign someone
to simulate a victim (active or distressed) after a prearranged signal from you,
such as a head nod.
■■ Begin the activity by allowing the swimmers to swim and play until you give the
signal and the drowning simulation begins.
■■ Once the rescue is complete, gather the group and discuss how it went and
what the next steps of the EAP would be.
■■ Repeat the activity until all participants have had the opportunity to be a
lifeguard or back-up lifeguard.

TOPIC: IN-WATER SKILL SESSION— Time: 1 hour, 10 minutes
RESCUE SKILLS, PART 2
SUBMERGED VICTIM RESCUES AND EXTRICATION
SKILL Instructor's Note: Follow these safety tips when practicing rescues
PRACTICE : for victims submerged in deep water:
■■ Instruct participants that if they experience difficulty when playing
the role of a victim, they should signal “let go” to the lifeguard by a
predetermined safety signal, such as a tap or gentle pinch.
REFERENCES: ■■ Explain that ear and sinus squeeze can be uncomfortable and, for
Course those with congestion, it can be painful or even cause damage
Presentation: to the ear. In this course, when practicing rescues of submerged
Slides 28-31 victims, participants are required only to go to a depth of 7 to 10
Participant’s feet. However, when hired to work at a facility with deeper water,
Manual: they would be expected to be able to go all the way to the bottom.
Chapter 6

■■ For the Shallow Water Lifeguarding Course, participants are required only to
go to a maximum depth of 5 feet.
Instructor's Note: When demonstrating the submerged victim

rescue, start with a skill demonstration on the pool deck to show
participants the correct position of the rescue tube and demonstrate
how to "climb up the tube" while bringing a submerged victim to
the surface. Following the land demonstration, conduct an in-water
demonstration so that participants can see the correct lifeguard
and rescue tube position (the rescue tube should be vertical as the
lifeguard approaches the surface of the water).
■■ Ask participants: Do you have any questions about the submerged victim
rescue skills that you observed in the eLearning video?
■■ Ask participants: What are some examples of submerged victim rescue
skills that you saw in the eLearning module and in your Lifeguarding
Manual?
cc Passive Submerged Victim–Shallow Water
cc Submerged Victim in Deep Water
■■ Ask participants: When performing a submerged victim rescue in deep
water, technique should lifeguards use to submerge underwater to
reach the victim?
cc Feet-First Surface Dive
cc Head-First Surface Dive
■■ Ask participants: After performing a rescue, what factors should you
consider when deciding which extrication technique to use?
cc The victim's size
cc The victim's condition
cc Characteristics of the facility (attractions with stairs or moving water, zero
depth entry)

SKILL ■■ Explain to participants that during the water rescue skill sessions, you will
PRACTICE: demonstrate each skill that they saw in the videos included in the eLearning module
and guide participants through practice.
■■ Explain that swim goggles may not be used for rescues of submerged victims
since they have no mechanism for pressure relief, which could result in injury to
the eyes when swimming in deeper water. They will be expected to open their
REFERENCES: eyes under water to perform rescues.
Participant’s
Manual: ■■ Pair up participants and explain that they will take turns as victim and rescuer for
Chapter 6 each skill. For the passive victim extrication using a backboard skill, participants
should form groups of three.
■■ For each skill, organize participants so that they can clearly see and hear. Be sure
to provide any instructions related to their position in the water or how they should
behave as victims.
■■ Explain to them that for each rescue skill, they should begin by simulating the
activation of the emergency action plan (EAP) (except when learning the surface
dives).
■■ Lead them through skill demonstrations followed by practice for the following skills:
cc Submerged Passive Victim in Shallow Water
●● Instructor demonstration on dry land
●● Victims: at least 10 yards from the edge of the pool

submerged in shallow water; passive
cc Feet-First Surface Dive in Deep Water
●● Instructor demonstration on dry land
●● Instructor demonstration in water
●● Participant practice in the water (with no victim)
cc Head-First Surface Dive in Deep Water (in water practice only)

●● Instructor demonstration in water
●● Participant practice in the water (with no victim)
cc Submerged Victim in Deep Water

●● Land demonstration—instructor demonstrates submerged victim
rescue on land. The tube should be placed overhead, such as
on a storage locker or diving board, or held by a participant.
●● Feet-first Surface Dive with Tube–skill practice–no victim
●● Submerged Victim Rescue–skill practice–with victim
●● Victims: at least 10 yards from the edge of the
pool submerged in deep water; passive
cc Extrication Using a Backboard at the Pool Edge
●● Assisting Responder: on deck with backboard
●● Victims: at least 10 yards away–passive
cc Optional: Extrication Using a Backboard at the Steps (hot tub or aquatic

attraction area)

PRACTICE: ■■ For the Shallow Water Lifeguarding course, omit the feet-first and head-first
continued surface dives and the submerged victim in deep water rescue unless necessary
to get to the bottom.
■■ Passive Victim Extrication Using a Backboard
cc Rescuing lifeguard: bringing victim to the edge of the pool after a passive
victim rescue
cc Assisting responder: on deck with backboard
cc Victim: passive
■■ Examples of common errors to point out include:
cc Submerged Passive Victim in Shallow Water: taking the rescue tube off
completely; victim’s head not in an open airway position during the tow; not
reaching over the tube for the tow; not hooking the towing arm tight during
the tow
cc Feet-First Surface Dive: positions that promote buoyancy rather than
submerging if the person is not submerging (holding the breath; looking
straight ahead or up toward the surface; using legs in a way to move to the
surface such as kicking movements that fight submerging; legs spread not
streamlined); not using sweeping arm movements to assist submerging
cc Head-First Surface Dive: positions that promote buoyancy rather than
support submerging if the person is not submerging (holding the breath; not
looking down toward the target; looking up toward the surface; not using
sweeping arm movements to assist submerging)
cc Submerged Victim in Deep Water: does not submerge to a position
“standing” behind the victim (heel to toe); does not grasp arm around the
victim’s chest; does not feed the tube strap into their hand as they move
toward the surface; unable to get the tube under the victim’s back before
breaking the surface; victim’s head not in an open airway position during the
tow; not reaching over the tube for the tow; not hooking the towing arm tight
during the tow
cc Extrication Using a Backboard at the Pool Edge: does not submerge board
deep enough; does not angle board once submerged to assist loading the
victim; does not control the board; does not control the board and the victim;
loses contact with the victim; does not keep the board low during removal;
drops the board after removal

TOPIC: PUTTING IT ALL TOGETHER Time: 1 hour
SKILL DRILL PART 1—PUTTING ON GLOVES WITH WET HANDS

SKILL DRILL: ■■ Assemble the participants on the deck and explain they will be practicing team
rescues for a submerged passive victim in deep water, removing the victim
from the water on a backboard and preparing to provide care by putting on
disposable gloves.
■■ Explain that they will be practicing how to put on gloves in a wet environment.
REFERENCES:
They will learn the method for glove removal in Lesson 5.
Participant’s
Manual: ■■ Explain that putting on gloves with wet hands can be challenging.
Chapter 6 ■■ Lead them through the skill of putting on gloves with wet hands. One method is
to dip the glove in the pool and fill with water and insert your hand in the glove.
■■ Participants should practice the skill until they are comfortable doing it quickly.
SKILL DRILL PART 2—SUBMERGED VICTIM RESCUE, EXTRICATION AND

GLOVES
SKILL DRILL: ■■ Divide the participants into groups of three and assign one rescuing lifeguard,
one victim and one assisting lifeguard for each group. Have both lifeguards
wear a hip pack with gloves inside.
■■ Explain for each group:
cc The rescuing lifeguard will simulate activating the EAP and enter the water.
REFERENCES:
Participant’s cc The victim will submerge to the bottom in deep water at the same time as
Manual: the rescuer. The rescuing lifeguard will rescue a victim who is submerged in
Chapter 6 deep water and passive.
cc While the rescuing lifeguard supports the victim at the edge, the assisting
lifeguard will bring the backboard and then remove the victim from the water,
demonstrating team communication skills between both lifeguards.
cc Once removed from the water, the victim will remain passive on the
backboard until all both lifeguards have put on their gloves.
■■ Repeat the drill until each person in the group has performed as a rescuing
lifeguard and an assisting lifeguard at least once.

■■ For the Shallow Water Lifeguarding course, have teams practice rescues for a
submerged passive victim in shallow water, removing the victim from the water
on a backboard and preparing to provide care by putting on disposable gloves.
■■ Participants will complete part one as it is described above. For part two, the
victim will submerge to the bottom in shallow water at the same time as the
rescuer. The rescuing lifeguard will rescue a victim who is submerged in shallow
water and passive.

SKILL DRILL PART 3—RESCUE AND EXTRICATION CHALLENGE
SKILL DRILL: ■■ Divide the participants into groups of four and assign one rescuing lifeguard,
one victim, and two assisting rescuers. Have them repeat the drill from part two
but challenge the groups to complete the extrication skill in under 1 minute.
REFERENCES:
Participant’s
Manual:
Chapter 6
SKILL DRILL PART 4: TEAM RESPONSE—RESCUE AND EXTRICATION

SKILL DRILL: ■■ Divide the participants into groups of four and assign one rescuing lifeguard,
one victim, and two assisting rescuers. Have them repeat the drill above but to
do the extrication using two additional rescuers to help with the backboard.
REFERENCES:
Participant’s
Manual:
Chapter 6
FOLLOW-UP ■■ Observe each participant’s performance of the skill and provide global and
ASSIGNMENT
cc Complete eLearning Module 5: Before Providing Care, Victim Assessment
and Breathing Emergencies.
REFERENCES:
●● Chapter 7, Before Providing Care and Victim Assessment
Course
Presentation: ●● Chapter 8, Breathing Emergencies
Slides 32

In addition to performing the steps listed in the skill chart in the correct order, participants must meet
the criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are
general for the category of skills, as well as specific to the skill, must be met.
ASSISTS
SKILL CHART: REACHING ASSIST FROM THE DECK
1. Extend the tube to the victim, keeping your body weight on your back foot and crouching to avoid
being pulled into the water.
■■ Remove the rescue strap from your shoulder if necessary to reach the victim and hold the
shoulder strap in one hand and extend the tube to the victim with the other hand.
2. Tell the victim to grab the rescue tube.
3. Slowly pull the victim to safety.
SKILL CHART: SIMPLE ASSIST

1. Approach the person who needs help while keeping the rescue tube between you and that person.
2. Reach across the tube and grasp the person at the armpit to help the person maintain their
balance.
■■ If the person is under water, grasp under the person’s armpits with both hands and help them
stand up.
3. Assist the person to the exit point, if necessary.
SKILL ASSESSMENT TOOL: ASSISTS

Communicates with the victim ■■ Victim is reassured and told ■■ No attempted verbal
what to do communication with
the victim
Maintains balance ■■ Assumes a sturdy posture ■■ Stumbles, falls or knocks
and stable footing victim under the water
Equipment is properly ■■ Control of the rescue tube is ■■ Rescue tube is not kept
positioned for the assist maintained between victim between victim and
and rescuer rescuer
Maintains support until victim is ■■ Supports the victim so that ■■ Victim’s mouth or nose is
safe the mouth and nose are under water
above water ■■ Lets go of victim without
■■ Assists the victim to a safe ensuring that the victim is at
position a position of safety
■■ Does not assist the victim out
of the water if needed

RESCUES AT OR NEAR THE SURFACE
SKILL CHART: ACTIVE VICTIM FRONT RESCUE
1. Approach the victim from the front.
2. As you near the victim, grab the rescue tube from under your arms with both hands and
begin to push the tube out in front of you. Continue kicking to maintain momentum.
3. Thrust the rescue tube slightly under water and into the victim’s chest, keeping the tube
between you and the victim. Encourage the victim to grab the rescue tube and hold onto it.
4. Keep kicking, fully extend your arms and move the victim to a safe exit point. Change
direction, if needed.
SKILL CHART: ACTIVE VICTIM REAR RESCUE

1. Approach the victim from behind with the rescue tube across your chest.
2. With both arms, reach under the victim’s armpits and grasp the shoulders firmly. Tell the victim that
you are there to help and continue to reassure the victim throughout the rescue.
3. Using your chest, squeeze the rescue tube between your chest and the victim’s back.
4. Keep your head to one side to avoid being hit by the victim’s head if it moves backwards.
5. Lean back and pull the victim onto the rescue tube.
6. Use the rescue tube to support the victim so the victim’s mouth and nose are out of the water.
7. Tow the victim to a safe exit point.
SKILL CHART: PASSIVE VICTIM FRONT RESCUE
1. Approach the face-down victim from the front with the rescue tube across your chest.
2. As you near the victim, reach one arm out toward the victim’s opposite arm and grab the victim’s
wrist/forearm while grabbing the rescue tube with your other hand.
3. Grasp the victim’s opposite wrist/forearm with your palm facing up on the underside of the victim’s
arm. Pull and twist the arm toward your opposite shoulder to turn the victim over on their back. As
you pull and twist, thrust the rescue tube under the victim’s back as they turn over.
4. Place the tube under the victim below the shoulders so that the victim’s head naturally falls back to
an open airway position. Keep the victim’s nose and mouth out of the water.
5. Reach one arm over the victim’s shoulder and grasp the rescue tube.
6. Use the other hand to stroke toward a safe exit point.
7. Remove the victim from the water, assess the victim’s condition and provide appropriate care.
SKILL CHART: PASSIVE VICTIM REAR RESCUE

1. Approach a face-down victim from behind with the rescue tube across your chest.
2. With both arms, reach under the victim’s armpits and grasp the shoulders firmly. You may be high
on the victim’s back when doing this.
3. Using your chest, squeeze the rescue tube between your chest and the victim’s back.
4. Keep your head to one side to avoid being hit by the victim’s head if it moves backwards.
5. Roll the victim over by dipping your shoulder and rolling onto your back so that the victim is face-up
on top of the rescue tube. Keep the victim’s mouth and nose out of the water. Place the tube under
the victim below the shoulders so that the victim’s head naturally falls back to an open-airway
position.
6. Reach one arm over the victim’s shoulder and grasp the rescue tube.
7. Use the other hand to stroke toward a safe exit point.
8. Remove the victim from the water, assess the victim’s condition and provide appropriate care.

SKILL ASSESSMENT TOOLS: RESCUES AT OR NEAR THE SURFACE
Communicates with the victim ■■ Victim is reassured and told ■■ No attempted verbal
what to do communication with the
victim
Equipment is properly positioned ■■ Rescue tube is kept between ■■ Rescue tube is not
for the appropriate rescue the lifeguard and the victim maintained between the
■■ Rescue tube is positioned victim and the rescuer
to support the victim at the ■■ The victim is not supported
surface of the water by the rescue tube
Victim’s mouth and nose above ■■ Victim’s mouth and nose are ■■ Victim’s mouth or nose is
water maintained above water under water
Tows the victim to a safe exit ■■ Victim is towed to a safe exit ■■ Victim is not supported
point point using the rescue tube by the rescue tube
to support the victim ■■ Releases contact with
the victim
ACTIVE VICTIM FRONT RESCUE
Rescue tube is placed to ■■ Rescue tube is slightly ■■ Rescue tube is thrust above
provide support for the victim submerged and thrust into victim’s armpits or in the
and safety for the rescuer the victim’s chest to provide stomach area and does not
support provide support
■■ Lifeguard’s arms are extended ■■ Lifeguard’s arms are not fully
with elbows locked extended
Moves the victim to a safe exit ■■ Forward momentum and kick ■■ Little to no forward
point are used to move the victim movement
to a safe exit point ■■ Unable to move the victim to
a safe exit point
ACTIVE VICTIM REAR RESCUE
Lifeguard squeezes the rescue ■■ Rescue tube remains in place ■■ Unable to tow the victim to a
tube against the victim’s back and is repositioned if it slips safe exit point
to provide support for the victim out ■■ Victim is not supported by
and safety for the rescuer the rescue tube
■■ Releases contact with the
victim

PASSIVE VICTIM FRONT RESCUE
Turns the victim to a face-up ■■ Pulls and twists the victim’s ■■ Unable to pull the victim to a
position opposite arm to turn the face-up position
victim over ■■ Rescue tube is not placed
■■ Rescue tube is thrust under under the victim’s back as the
the victim’s back as the victim victim is turned over
is turned over ■■ Unable to reposition the tube
if it slips out
Maintains head in an open ■■ Rescue tube is placed under ■■ Victim’s head is tilted forward
airway position at the surface the victim’s back so that the (chin toward chest)
victim’s head is in an open
airway position
Switches to a towing position ■■ Holds the victim’s wrist of ■■ Releases contact with the
one arm until in position with victim
other arm to tow the victim to ■■ The towing arm is not over
safety and around the rescue tube
■■ The towing arm is over and
around the rescue tube
PASSIVE VICTIM REAR RESCUE
Turns the victim to a face-up ■■ Rescue tube is squeezed ■■ Rescue tube is not
position between rescuer’s chest and maintained between the
victim’s back victim and the rescuer
■■ Leans back to pull victim ■■ Unable to reposition the tube
face-up if it slips out
■■ Unable to pull victim to a
face-up position
Maintains head in an open ■■ Rescue tube is placed under ■■ Victim’s head is tilted forward
airway position at the surface the victim’s back so that the (chin toward chest)
victim’s head falls back to an
open airway position
Switches to a towing position ■■ Holds the victim’s wrist of ■■ Releases contact with the
one arm until in position with victim
other arm to tow the victim to ■■ The towing arm is not over
safety and around the rescue tube
■■ The towing arm is over and
around the rescue tube

SKILL CHART: MULTIPLE-VICTIM RESCUE
If you are the only one rescuing two victims who are clutching each other:
1. Approach one victim from behind.
2. With both arms, reach under the victim’s armpits and grasp the shoulders. Squeeze the
rescue tube between your chest and the victim’s back, keeping your head to one side of the
victim’s head.
3. Use the rescue tube to support both victims with their mouths out of the water. Talk to the
victims to help reassure them.
4. Support both victims until other lifeguards arrive or the victims become calm enough to
move to a safe exit point.
SKILL ASSESSMENT TOOLS: MULTIPLE-VICTIM RESCUE
Communicates with the victims ■■ Victims are reassured and ■■ No attempted verbal
told what to do communication with the
victims
Equipment is properly positioned ■■ Rescue tube is kept between ■■ Rescue tube is not
for the appropriate rescue the lifeguard and the victims maintained between the
■■ Rescue tube is positioned victims and the rescuer
to support the victims at the ■■ The victims are not
surface of the water supported by the rescue tube
Victims’ mouths and noses ■■ Victims’ mouths and noses ■■ Victims’ mouths or noses are
above water are maintained above water under water
Tows the victims to safety ■■ Victims are towed to safety ■■ Unable to tow the victims to
using the rescue tube to safety
support the victims ■■ Victims are not supported by
the rescue tube
victims
Rescue tube is placed to ■■ Maintains firm hold of one ■■ Both victims are not
provide support for victims and victim and rescue tube supported
safety for rescuer effectively supports both
victims’ heads above water
SUBMERGED VICTIM
SKILL CHART: PASSIVE SUBMERGED VICTIM IN SHALLOW WATER
1. Swim or quickly walk to the victim’s side. Let go of the rescue tube but keep the strap
around your shoulders.
2. Submerge and reach down to grab the victim under the armpits.
3. Simultaneously, pick up the victim, move forward and roll the victim face-up upon surfacing.
4. Grab the rescue tube and position it under the victim’s shoulders. The victim’s head should
naturally fall back into an open-airway position. If an assisting lifeguard is there with the
backboard, skip this step and proceed to remove the victim from the water.
5. Move the victim to a safe exit point, remove the victim from the water, assess the victim’s
condition and provide appropriate care.

SKILL CHART: SUBMERGED VICTIM IN DEEP WATER (LIFEGUARDING COURSE ONLY)
1. Release the rescue tube, perform a feet-first surface dive and position yourself behind the victim.
2. Reach one of your arms under the victim’s arm (your right arm under their right arm or your left arm
under their left arm) and across the victim’s chest. Hold firmly onto the victim’s opposite side.
3. Once you have hold of the victim, reach up with your free hand and grasp the towline. Pull it down
and feed the line to the hand that is holding the victim. Keep feeding the towline this way until
nearing the surface.
4. As you approach the surface, grasp and position the rescue tube so it is placed on the victim’s
back, below their shoulders.
5. Upon reaching the surface, ensure that the victim is positioned on the rescue tube and the victim’s
head is back in an open-airway position.
6. Reach your free arm over the tube and under the victim’s armpit. Grasp the rescue tube firmly.
7. Tow the victim to a safe exit point. Remove the victim from the water, assess the victim’s condition
and provide appropriate care.
Note: As you descend into deep water, be sure to equalize pressure early and often. If you are
unable to equalize pressure, return to the surface.
SKILL ASSESSMENT TOOL: SUBMERGED VICTIM RESCUES
Equipment is properly ■■ Rescue tube is positioned under ■■ Victim slides off tube
positioned to provide support the victim’s back and is supporting ■■ Victim’s head submerges
for the victim upon rolling over the victim at the surface
or surfacing
Victim is face-up upon ■■ Victim is quickly brought to a ■■ Victim is face-down
surfacing face-up position ■■ Unable to turn victim to
a face-up position upon
surfacing
Victim’s mouth and nose are ■■ Victim’s mouth and nose are ■■ Victim’s mouth or nose is
above water maintained above water under water
Maintain head in an open ■■ Rescue tube is placed under the ■■ Victim’s head is tilted
airway position at the surface victim’s back so that the victim’s forward (chin toward
head falls back to an open airway chest)
position
Switch to a towing position Holds the victim’s wrist of one arm Releases contact with the
■■ ■■
until in position with other arm to victim
tow the victim to safety ■■ The towing arm is not
over and around the
rescue tube
Tow the victim to safety ■■ Victim is towed to a safe exit point ■■ Unable to make progress
using the rescue tube to support in the water to move the
the victim victim to a safe exit point
■■ Victim is not supported by
the rescue tube and slips
off or submerges
SUBMERGED PASSIVE VICTIM IN SHALLOW WATER
Equipment is properly ■■ Rescue strap is around the ■■ Tries to submerge with
positioned to start the rescue shoulder of the rescuer the rescue tube
■■ Rescue tube strap is not
worn over the shoulder

SUBMERGED PASSIVE VICTIM IN SHALLOW WATER, CONTINUED
Victim brought to the surface ■■ Submerges to grasp victim ■■ Unable to submerge
■■ Maintains grasp of the victim and ■■ Does not make contact
brings to the surface with victim
■■ Drops victim
■■ Unable to return to the
surface with victim
SUBMERGED VICTIM IN DEEP WATER (LIFEGUARDING COURSE ONLY)
Equipment is properly ■■ Rescuer releases rescue tube so it ■■ Tries to submerge with
positioned appropriate to the remains at the surface the rescue tube
rescue ■■ Rescue tube strap is worn around ■■ Loses contact with the
the shoulder rescue tube strap—not
■■ For water deeper than the tube worn around the shoulder
strap length, strap is removed from or not held
the shoulder and held ■■ Unable to grasp rescue
tube once returned to the
surface to place under the
victim’s back
Victim brought to the surface ■■ Submerges to grasp the victim ■■ Unable to submerge
■■ Maintains grasp of the victim and ■■ Cannot grasp the victim
brings to the surface ■■ Does not make contact
■■ Rescue tube placed under the with the victim
victim’s back upon surfacing ■■ Drops the victim
■■ Unable to return to the
surface with the victim
■■ Unable to grasp or place
rescue tube under the
victim upon surfacing
SURFACE DIVES
SKILL CHART: FEET-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)
1. Swim to a point near and above the victim. Release the rescue tube but keep the strap
around your shoulders.
2. Position your body vertically, then at the same time, press both hands down to your sides
and kick strongly to raise your body out of the water.
3. Take a breath, then let your body sink under water as you begin to extend your arms outward
with palms upward, pushing against the water to help you move downward. Keep your legs
straight and together with toes pointed. Tuck your chin and turn your face to look down
toward the bottom.
4. As downward momentum slows, repeat the motion of extending your arms outward and
sweeping your hands and arms upward and overhead to go deeper.
5. Repeat this arm movement until deep enough to reach the victim.
If you must swim under water, such as for a deep-water line search, also perform these steps:
1. When deep enough, tuck your body and roll to a horizontal position.
2. Extend your arms and legs and swim under water.

SKILL CHART: HEAD-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)
1. Swim to a point near the victim and release the rescue tube.
2. Gain momentum using a swimming stroke.
3. Take a breath, sweep your arms backwards to your thighs and turn them palms-down.
4. Tuck your chin to your chest and flex at the hip sharply while your arms reach downward
toward the bottom.
5. Lift your legs upward, straight and together so that their weight above the water helps the
descent. Get in a fully extended, streamlined body position that is almost vertical.
6. If you need to go deeper, such as in a diving well, do a simultaneous arm pull with both arms
to go deeper, then level out and swim forward under water.
Tip: If the depth of the water is unknown or the water is murky, hold one or both arms
extended over the head toward the bottom or use a feet-first surface dive.
SKILL ASSESSMENT TOOL: SURFACE DIVES
Submerge to appropriate depth ■■ Submerges to appropriate ■■ Unable to submerge to
depth appropriate depth
Look toward bottom while ■■ Face is looking down toward ■■ Face is looking forward or
descending bottom while descending upward while descending
FEET-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)
Body descends feet-first in a ■■ Legs are held together ■■ Legs are apart and impede
streamlined position ■■ Arms are fully extended descent
overhead ■■ Arm positioning impedes
descent
HEAD-FIRST SURFACE DIVE (LIFEGUARDING COURSE ONLY)
Body descends head-first in a ■■ Legs are held together and ■■ Legs are apart
streamlined position lifted upward toward the ■■ Body is not nearly vertical
surface to aide descent during descent
■■ Arms reach downward ■■ Arms are not in front reaching
toward the bottom downward

EXTRICATION FROM WATER
SKILL CHART: EXTRICATION USING A BACKBOARD - AT THE POOL EDGE
1. The rescuing lifeguard swims with the victim toward the side of the pool. The assisting
responder(s) on deck brings the backboard to the edge of the water and removes the head
immobilizer.
2. The assisting responder then places the board in the water vertically. The rescuing lifeguard
approaches the backboard and moves to the side of the victim, while the assisting responder
grasps the victim’s wrist with one hand while holding the backboard with their other hand.
3. The rescuing lifeguard raises one of the victim’s arms so that the assisting responder can grasp the
arm. The rescuing lifeguard then slides the rescue tube out from under the victim and toward him
before contact is made with the board.
4. The assisting responder on deck firmly holds the backboard with one hand and the victim’s forearm
with the other hand, as the rescuing lifeguard stabilizes the backboard from the side.
■■ If more than one on-deck responder is available, they should help hold and stabilize the
backboard.
5. Once the victim is centered on the backboard, the assisting responder(s) signals that they are
ready to remove the victim. While maintaining his or her hold on the victim’s arm, the assisting
responder(s) on deck pulls the backboard onto the deck. The rescuing lifeguard pushes the
backboard as the assisting responder(s) pulls.
■■ If more than one on-deck responder is available, they should help hold the backboard and pull
the backboard onto the deck.
6. Assess the victim’s condition and provide appropriate care.
SKILL ASSESSMENT TOOL: EXTRICATION FROM WATER USING A BACKBOARD—AT THE
POOL EDGE
Backboard is submerged into ■■ Backboard head immobilizer ■■ Unable to submerge the
position blocks are removed and backboard
backboard is placed ■■ Unable to stabilize the
vertically, against the wall backboard
■■ Maintains control of the
backboard
Lifeguards communicate with ■■ Lifeguard(s) communicates ■■ Lifeguards cannot proceed
each other what, how and/or when with removing the victim from
actions happen the water
Victim’s head remains above the ■■ Victim’s mouth and nose are ■■ Victim’s mouth or nose is in
surface of the water maintained out of the water the water
Victim is placed onto the board ■■ Rescuing lifeguard moves to ■■ Unable to place victim on the
the side of the victim. backboard
■■ Rescuing lifeguard raises ■■ Loses contact with
one of the victim’s arms; the backboard or victim
assisting responder grasps
the victim’s forearm

SKILL CHART: EXTRICATION USING A BACKBOARD—ZERO DEPTH ENTRY
1. The rescuing lifeguard supports the victim in a face-up position with the victim’s arms extended
alongside the victim’s head until another lifeguard arrives with the backboard.
2. The assisting responder removes the head-immobilizer device, enters the water, submerges the
backboard and positions the board under the victim so that it extends slightly beyond the victim’s
head. The assisting lifeguard raises the backboard into place.
3. Each lifeguard moves behind the victim’s head. Each lifeguard grasps one of the victim’s wrists and
one of the handholds of the backboard and begins to move toward the zero-depth entry.
4. After reaching the zero-depth entry, the lifeguards slightly lift the head-end of the backboard,
carefully pulling the backboard out of the water.
SKILL ASSESSMENT TOOL: EXTRICATION USING A BACKBOARD – ZERO-DEPTH ENTRY

backboard is submerged ■■ Unable to stabilize the
underneath the victim backboard
backboard
■■ Each lifeguard grasps one
of the victim’s wrists and
one of the handholds of the
backboard and begins to
move toward the zero-depth
entry
Victim is placed onto the board ■■ Victim’s body is on the ■■ Victim’s body is not aligned
backboard and on the backboard
■■ Victim’s head is positioned on ■■ Victim’s head is not
the backboard’s head space positioned on the
backboard’s head space
Victim is pulled out on the ■■ The lifeguards slightly lift the ■■ Is unable to pull the
backboard head-end of the backboard, backboard and victim onto
carefully pulling the land
backboard out of the water ■■ Does not demonstrate good
body mechanics while pulling
the backboard and victim
onto land

SKILL CHART: EXTRICATION USING A BACKBOARD AT THE STEPS
1. The rescuing lifeguard swims with the victim toward the side of pool. The assisting responder(s)
on deck brings the backboard to the steps and removes the head immobilizer.
2. The assisting responder(s) on deck places the board in the water at an angle against the stairs.
The rescuing lifeguard approaches the backboard and moves to the side of the victim.
3. The rescuing lifeguard raises both of the victim’s arms so that the assisting responder(s) can
grasp the arm(s).
4. The assisting responder on deck firmly holds the backboard with one hand and the victim’s
forearm with the other hand, as the rescuing lifeguard stabilizes the backboard from the side.
5. If more than one on-deck responder is available, they should help hold and stabilize the
backboard. Once the victim is centered on the backboard, the assisting responder(s) signals
that they are ready to remove the victim. While maintaining his or her hold on the victim’s arm, the
assisting responder(s) on deck pulls the backboard at an angle up the stairs and onto the deck.
The rescuing lifeguard pushes the backboard as the assisting responder(s) pulls. If more than one
on-deck responder is available, they should grasp the backboard and the victim’s other forearm to
help pull the backboard up the stairs.
SKILL ASSESSMENT TOOL: EXTRICATION USING A BACKBOARD - AT THE STEPS
backboard
Victim is placed onto the board ■■ The rescuing lifeguard raises ■■ Victim’s body is not aligned
one of the victim’s arms so and on the backboard
that the assisting responder ■■ Victim’s head is not
can grasp the arm positioned on the
■■ Assisting rescuer holds the backboard’s head space
backboard with one hand and
the victim’s forearm with the
other hand
■■ Victim’s body is on the
backboard
■■ Victim’s head is positioned on
the backboard’s head space
Victim is pulled out on the ■■ The assisting responder(s) ■■ Is unable to pull the
backboard in a safe manner for on deck pulls the backboard backboard and victim onto
rescuers and victim onto the deck while land
maintaining hold on the ■■ Does not demonstrate good
victim’s arm body mechanics while pulling
■■ The rescuing lifeguard the backboard and victim
pushes the backboard as the onto land
assisting responder(s) pulls ■■ Drops backboard and victim
■■ Backboard is carefully
lowered to the ground

SKILL CHART: EXTRICATION USING A BACKBOARD–STEEP STEPS AND/OR MOVING
WATER ATTRACTIONS
1. The rescuing lifeguard supports the victim in a face-up position with the victim’s arms extended
alongside the victim’s head until another lifeguard arrives with the backboard.
■■ In moving water, the rescuing lifeguard should position the victim so that their head is pointed
upstream. This position will help keep the victim’s body in alignment for easier placement of the
backboard and reduce splashing of water on to the victim’s face.
2. The assisting responder removes the head-immobilizer device, enters the water, submerges the
backboard and positions the board under the victim so that it extends slightly beyond the victim’s
head. The assisting lifeguard raises the backboard into place.
3. Each lifeguard moves behind the victim’s head. Each lifeguard grasps one of the victim’s wrists and
one of the handholds of the backboard and begins to move toward the zero-depth entry.
4. Lifeguards carefully and gently drag the backboard, taking one step at a time until they reach the
top of the steps.
5. Gently lower the backboard to the ground.
SKILL ASSESSMENT TOOL: EXTRICATION USING A BACKBOARD—STEEP STEPS AND/OR
MOVING WATER ATTRACTIONS
backboard
■■ Each lifeguard grasps one
of the victim’s wrists and
one of the handholds of the
backboard and begins to
move toward the zero-depth
entry
Victim is placed onto the board ■■ Victim’s body is on the ■■ Victim’s body is not aligned
backboard and on the backboard
■■ Victim’s head is positioned on ■■ Victim’s head is not
the backboard’s head space positioned on the
backboard’s head space
Victim is pulled out on the ■■ Carefully and gently drag the ■■ Is unable to pull the
backboard backboard, taking one step at backboard and victim up the
a time until they reach the top steps onto land
of the steps ■■ Does not demonstrate good
body mechanics while pulling
the backboard and victim
onto land
■■ Drops backboard and victim

LESSON 5
BEFORE PROVIDING CARE, VICTIM
ASSESSMENT AND BREATHING EMERGENCIES

■■ Complete the skills practice for Removing Disposable Gloves.
■■ Discuss all points in the topic Standard Precautions.
■■ Discuss all points in the topic General Procedures for an Emergency on Land.
■■ Guide the discussion on Scene Size-up.
■■ Discuss all points in the topic Performing a Primary Assessment.
■■ Guide the discussion on Performing a Primary Assessment.
■■ Complete the skill practice for Using a Resuscitation Mask.
■■ Complete the skill practice for Primary Assessment—Adult and Child.
■■ Complete the skill practice for Primary Assessment—Infant.
■■ Discuss all points in the topic Moving a Victim.
■■ Discuss all points in the topic Recognizing and Caring for Breathing Emergencies.
■■ Discuss all points in the topic Giving Ventilations.
■■ Complete the skill practice for Giving Ventilations.
■■ Discuss all points in the topic Giving Ventilations Using a Bag-Valve-Mask Resuscitator.
■■ Show the video segment “Using a Bag-Valve-Mask-Resuscitator—Two Rescuers.”
■■ Complete the skill practice for Using a Bag-Valve-Mask Resuscitator—Two Rescuers.
■■ Discuss all points in the topic Airway Obstruction.
■■ Show the video segment “Conscious Choking—Adult and Child.”
■■ Complete the skill practice for Conscious Choking—Adult and Child.
■■ Show the video segment “Conscious Choking—Infant.”
■■ Complete the skill practice for Conscious Choking—Infant.
cc Standard Precautions
cc Primary Assessment
cc Recognizing and Caring for Breathing Emergencies
cc Airway Obstructions

LESSON OBJECTIVES
■■ Describe what standard precautions to take to prevent disease transmission when providing
care.
■■ Demonstrate proper removal of disposable gloves.
■■ Describe the general procedures for injury or sudden illness on land.
■■ Identify items of concern when conducting a scene size-up and forming an initial impression.
■■ Demonstrate how to perform a primary assessment and place a victim in a recovery position.
■■ Identify victim conditions that indicate the need to summon emergency medical services (EMS)
personnel.
■■ Understand how to safely and effectively move a victim on land.
■■ Demonstrate how to use a resuscitation mask.
■■ Recognize and care for a breathing emergency.
■■ Demonstrate how to safely and effectively give ventilations.
■■ Demonstrate how to safely and effectively use a bag-valve-mask (BVM) resuscitator with two
rescuers.
■■ Demonstrate how to safely and effectively care for an obstructed airway for a conscious and an
unconscious victim.

■■ Manikins (one adult and one infant manikin for every two participants, child manikins optional)
■■ Pediatric resuscitation masks (one per participant)
■■ Bag-valve-mask (BVM) resuscitators (adult and infant, one for each manikin, child BVMs
optional)
■■ Decontamination supplies
LESSON PREPARATION
■■ Be prepared to answer questions participants may have about the review questions they
completed.
■■ Select and arrange for a location that is appropriate to conduct the Lifeguard Response Time
Testing Drill activity in advance. Be prepared by discussing the drill with facility management
and the lifeguarding staff on duty so that the staff on duty are aware and do not mistake the
drill for an actual emergency. If possible, conduct the drill in an area of the pool not crowded by
patrons.

INSTRUCTOR NOTES
completion certificates they received when they completed eLearning Module 5: Before
Providing Care, Victim Assessment and Breathing Emergencies.
■■ Training information and skill sheets for the administration of epinephrine and for the
administration of inhalers can be found on the Red Cross Learning Center.
■■ It is not necessary to practice the primary assessment and recovery position for an adult and a
child. Have participants practice the primary assessment and a recovery position for an adult.
Then, have participants as a group explain the elements that are unique when performing the
primary assessment for a drowning victim, including when to give ventilations, as well as unique
elements when performing the primary assessment on a child, including getting consent,
opening the airway and giving ventilations.
■■ Choose either the practice-while-you-watch or watch-then-practice method for the Giving
Ventilations skill practice.
■■ Participants need only demonstrate how to provide ventilations for an adult. Have participants
as a group explain the differences for a child, such as how far to tilt the head or using a
pediatric mask.
■■ Participants need only demonstrate how to care for conscious choking for an adult. Have
participants as a group explain the differences for a child such as kneeling if the victim is
shorter.
TEACHING TIPS
practice.
■■ When using the practice-while-you-watch method for Giving Ventilations, do not interrupt this
skill session to lecture or communicate anything other than guidance related to skill practice.
In general, answering questions should occur after the video segment (and skill session) has
ended.
■■ Arrange the manikins so the heads are facing the same direction to make it easier for you to
observe and assess participant performance.

TOPIC: STANDARD PRECAUTIONS Time: 5 minutes
STANDARD PRECAUTIONS
LECTURE: ■■ Ask participants: Do you have any questions about the video “Standard
Precautions”?
■■ Ask participants: What are the diseases that are of primary concern for
you as a lifeguard?
REFERENCES: Answers: Responses should include the following:
cc Hepatitis B
Course
Presentation: cc Hepatitis C
Slides 35 cc HIV
Participant’s
Manual:
Chapter 7
REMOVING DISPOSABLE GLOVES

SKILL ■■ Provide all participants with disposable non-latex gloves.
PRACTICE: ■■ Explain that participants will have many opportunities to practice glove
removal since they will be following procedures each time they remove gloves
throughout the remainder of this course.
■■ Lead participants through the skill of Removing Disposable Gloves.
REFERENCES: ■■ Observe each participant’s performance of the skill and provide global and
Participant’s
Manual: commend correct skill practice.
Chapter 7
TOPIC: G
ENERAL PROCEDURES FOR Time: 5 minutes
AN EMERGENCY ON LAND
SCENE SIZE-UP
GUIDED ■■ Tell participants that the first step in the general procedures is the scene
DISCUSSION: size-up. A scene size-up is the careful and systematic approach of a scene to
get a full picture of the emergency situation.
■■ Ask participants: Using your senses, what information can you gather
about the scene of an emergency?
REFERENCES:
cc Sight: Hazardous conditions, number of victims, number of bystanders
Course
Presentation: cc Smell: Odors that might suggest chemical release, intoxication, diabetic
Slide 37-38 emergency or burning objects
Participant’s cc Hearing: Unusual sounds, cries for help, splashing
Manual: ■■ Ask participants: Why else is a scene size-up necessary?
Chapter 7
cc To ensure scene safety for the rescuers, the victims and any bystanders
cc To identify necessary PPE
cc To form an initial impression by looking for signs that might indicate a life-
threatening emergency
cc To determine the mechanism of injury or nature of the illness
cc To determine the number of victims
cc To identify what additional help may be required

TOPIC: P
ERFORMING A PRIMARY Time: 35 minutes
ASSESSMENT
PERFORMING A PRIMARY ASSESSMENT
LECTURE: ■■ A primary assessment is conducted to identify any life-threatening
conditions.
■■ The steps for a primary assessment include the following:
cc Check the victim for responsiveness using a shout-tap-shout
REFERENCES: sequence. When checking a child or infant, obtain consent from a

Course parent or guardian before providing care, if possible.
Presentation: cc Open the victim’s airway and check for breathing and a pulse
Slides 40-42 simultaneously.
Participant’s ●● Check for a carotid pulse in an adult and a child. Check for a
Manual:
Chapter 7
brachial pulse in an infant.
●● If the chest does not clearly rise when attempting either of
the first 2 ventilations, re-tilt the head and try to give another
ventilation.
●● If after the second attempt the chest clearly rises, give 1 more
ventilation so there are two successful ventilations.
●● If after the second attempt the chest does not clearly rise,
immediately give CPR.
●● Do not attempt giving more than 3 ventilations total.
■■ In general, if a victim is unresponsive but breathing and you do not

suspect a head, neck or spinal injury, place the victim in a side-lying
recovery position. A recovery position should also be used whenever
you are alone and need to leave the scene (e.g., to call for help).
Science Note:
■■ Checking for responsiveness: When checking a person
for responsiveness, sometimes a tapping of the shoulder does
not provide enough physical stimuli to elicit a response to pain.
Therefore, a trained responder could employ a “shout-tap-pinch”
approach with a pinch to the muscle between the neck and
shoulder in order to provide a stronger physical stimulus to a
sensitive area. It is important that “shout-tap-pinch” does not
delay patient care by adding extra time to determine a response
to verbal or painful stimuli.
■■ Recovery Positions: Based on the available evidence, it is
important to turn a person who is responsive and breathing
normally but not fully awake onto their side to lower the risk for
choking and aspiration. There is little evidence to suggest an
optimal recovery position. However, turning the victim towards
the rescuer, rather than away from the rescuer, allows for more
control over the movement and facilitates monitoring the victim’s
airway.
■■ Ventilations for Drowning Victims: Due to the hypoxic
nature of drowning, lifeguards and professional responders
should alter the initial treatment for victims with no breathing
or no pulse as a result of a drowning and provide 2 initial
ventilations during the primary assessment prior to beginning
CPR with chest compressions.

PERFORMING A PRIMARY ASSESSMENT
GUIDED ■■ Ask participants: Do you have any questions about the “Primary
DISCUSSION: Assessment” video?
■■ Ask participants: What types of life-threatening conditions are you
looking for during a primary assessment?
Answer: Is the victim breathing and does the victim have a pulse?
REFERENCES: ■■ Ask participants: In what situations would you give 2 ventilations during
Course the primary assessment?
Presentation: Answer: For any victim who is not breathing and has no pulse as a result of a
Slides 43–47 drowning
Participant’s ■■ Ask participants: How long do you check for a pulse and breathing
Manual:
Chapter 7
during the primary assessment?
Answer: At least 5 seconds but no more than 10 seconds.
■■ Ask participants: What are the techniques for opening a victim’s airway
to give ventilations?
Answers: From the victim’s side: Use the head-tilt/chin-lift. From above the
victim’s head: Tilt the head back using the jaw-thrust maneuver. If the victim is
suspected of having a head, neck or spinal injury, use the jaw-thrust (without
head extension) maneuver.
■■ Ask participants: What should you do if your ventilation does not make
the victim’s chest clearly rise?
Answer: Re-tilt the victim’s head and re-attempt another ventilation.
SKILL ■■ Ask participants to take their participant’s manual and disposable gloves to the
PRACTICE: practice area.
■■ Ask participants to find a partner. One person will be the responder while the
other person will be the injured or ill person, then they will switch roles.
■■ Guide participants through the steps listed on the Performing a Primary
Assessment skill chart. Once participants have completed the primary
REFERENCES: assessment, have them practice the recovery position.
Participant’s
Manual: ■■ Guide them through the steps listed on the recovery position skill chart.
Chapter 7 ■■ Observe each participant’s performance of the skill and provide global and
■■ Examples of common errors to point out include: failing to size up the scene,
failing to determine responsiveness, failing to follow standard precautions,
improperly opening the airway, checking an inappropriate pulse site or not
looking at the chest while checking for breathing.
Instructor’s Note: It is not necessary to practice the primary © 2011, 2017, 2019 The American National Red Cross. All rights reserved.
assessment and recovery position for an adult and a child.
Have participants practice the primary assessment and a
recovery position for an adult. Then, have participants as a
group explain the elements that are unique when performing the
primary assessment for a drowning victim, including when to
give ventilations, as well as unique elements when performing
the primary assessment on a child, including getting consent,
opening the airway and giving ventilations.

USING A RESUSCITATION MASK
SKILL ■■ Ask participants: Do you have any questions about the “Giving
PRACTICE: Ventilations—Adult, Child and Infant” video?
■■ Ask participants to take their participant’s manual, disposable gloves and
resuscitation masks to the practice area.
■■ Using a manikin, guide participants through the three methods for giving
ventilations using each of the following methods:
REFERENCES:
cc Head-Tilt/Chin-Lift Technique
Course
Presentation: cc Jaw-Thrust (with Head Extension) Maneuver
Slides 48 cc Jaw-Thrust (without Head Extension) Maneuver
Participant’s ■■ Observe each participant’s performance of the skill and provide global and
Manual: individual feedback during skill practice to correct common mistakes or
Chapter 7
■■ Examples of common errors to point out include: not opening the airway,
improperly opening the airway, not obtaining a seal with the resuscitation mask,
or not making the chest rise and fall, not looking at the chest while checking for
breathing.
PRIMARY ASSESSMENT—INFANT
SKILL ■■ Using a manikin, guide participants through the steps listed on the Primary
PRACTICE: Assessment skill chart.
■■ Once participants have completed the primary assessment, have them practice
the recovery position. Guide participants through the steps listed on the
Recovery Position skill chart.
REFERENCES: individual feedback during skill practice to correct common mistakes or
Participant’s commend correct skill practice.
Manual:
Chapter 7 ■■ Examples of common errors to point out include: failing to size up the scene,
failing to obtain consent, failing to determine responsiveness, failing to follow
standard precautions, improperly opening the airway, checking an inappropriate
pulse site, not looking at the chest while checking for breathing.
SUMMONING EMS PERSONNEL

GUIDED ■■ Ask participants: What other conditions that may occur in the aquatic
DISCUSSION: environment might require summoning EMS personnel?
cc Any victim recovered from underwater who may have inhaled water
cc Seizures in the water
REFERENCES: cc Suspected or obvious injuries to the head, neck or spine

Course
Presentation:
Slides 49
Participant’s
Manual:
Chapter 7

TOPIC: M OVING A VICTIM Time: 5 minutes
MOVING A VICTIM
GUIDED ■■ Moving a victim needlessly or improperly can lead to further pain and
DISCUSSION: injury.
■■ Ask participants: What factors should be considered when deciding
whether or not to move a victim?
cc You are faced with immediate danger
REFERENCES:
Course cc You need to get to other victims who have more serious injuries or illnesses
Presentation: cc It is necessary to provide appropriate care (e.g., moving a victim to the top or
Slides 51-54 bottom of a flight of stairs to perform Cardiopulmonary Resuscitation [CPR])
Participant’s ■■ If you must leave a scene to ensure your personal safety, you should
Manual: make reasonable attempts to move the victim to safety as well.
Chapter 7
■■ Ask participants: If you have to move a victim, what factors should be
considered in deciding what method to use?
cc The victim’s height and weight
cc Your physical strength
cc Obstacles, such as stairs and narrow passages
cc The distance to be moved
cc Whether others are available to assist
cc The victim’s condition
cc Whether aids to transport are readily available

TOPIC: R
ECOGNIZING AND CARING FOR Time: 5 minutes
BREATHING EMERGENCIES
RECOGNIZING AND CARING FOR BREATHING EMERGENCIES
GUIDED ■■ There are two types of breathing (also referred to as respiratory)
DISCUSSION: emergencies:
cc Respiratory distress is a condition in which breathing becomes
difficult.
cc Respiratory arrest is a condition in which breathing stops.
REFERENCES: ■■ Respiratory distress may lead to respiratory arrest.

Course ■■ Ask participants: What are some signs and symptoms of a person in
Presentation: respiratory distress?
Slides 56-58 Answers: Responses should include the following:
Participant’s cc Slow or rapid breathing
Manual:
cc Unusually deep or shallow breathing
Chapter 8
cc Shortness of breath or noisy breathing
cc Dizziness, drowsiness or light-headedness
cc Changes in level of consciousness
cc Increased heart rate
cc Chest pain or discomfort
cc Skin that is flushed, pale, ashen or bluish
cc Unusually moist or cool skin
cc Gasping for breath
cc Wheezing, gurgling or high-pitched noises
cc Inability to speak in full sentences
cc Tingling in the hands, feet or lips
cc Apprehensive or fearful feelings
■■ Refer participants to Chapter 8, Breathing Emergencies, in the Lifeguarding
Manual. Point out the sidebars on asthma and anaphylaxis. Explain that if they
will be required to administer epinephrine, they may need to undergo additional
training conducted at their facility.
Instructor’s Note: Training information and skill sheets for the

administration of epinephrine and for the administration of inhalers
can be found on the Red Cross Learning Center.

GUIDED
DISCUSSION: Science Note:
continued ■■ Respiratory Arrest: Hyperventilation most commonly occurs
when victims are being ventilated in respiratory arrest or when
an advanced airway is placed during cardiac arrest. It is critical
to avoid hyperventilation of the victim because it leads to
increased pressure and a subsequent decrease in cardiac filling
and cardiac perfusion pressures by putting pressure on the
vena cava (the main chest vein).
■■ Opioid Overdose: With a growing epidemic of opioid
(commonly heroin and oxycodone) overdoses in the United
States, local and state departments of health have increased
access to the medication naloxone, which can counteract the
effects of overdose including respiratory arrest. Naloxone (also
referred to by its trade name NarcanTM) has few side effects and
can be administered intranasally (through the nose). Trained
responders should administer the drug when the patient is
in respiratory arrest and an opioid overdose is suspected.
Lifeguards and professional responders should follow local
medical protocols and regulations to determine dosing and
timing of naloxone administration.
TOPIC: G IVING VENTILATIONS Time: 15 minutes
GIVING VENTILATIONS—ADULT AND CHILD

SKILL
PRACTICE: Instructor’s Note: Participants need only demonstrate how to
provide ventilations for an adult. Have participants as a group
explain the differences for a child, such as how far to tilt the head
or using a pediatric mask.
REFERENCES: ■■ Choose either the practice-while-you-watch or watch-then-practice method for
Participant’s this skill practice.
Manual:
Chapter 8 ■■ Observe each participant’s performance of the skill and provide global and
■■ Examples of common errors to point out include: not tilting the head, tilting the
head too far back, not looking at the chest when assessing for breathing, not
noticing if the ventilations are inadequate (do not cause the chest to rise), failing
to reassess for breathing and pulse, providing ventilations at the incorrect ratio,
breathing too hard or too soft, not obtaining a seal with the resuscitation mask,
using an improperly sized mask for the victim or not counting out loud.

SKILL PRACTICE-WHILE-YOU-WATCH
PRACTICE
AND VIDEO ■■ Ask participants to take their disposable gloves and resuscitation masks to the
SEGMENT: practice area.
■■ Explain to the participants that, for this skill, they will follow along with and
practice the steps for giving ventilations to an adult as they are guided by the
video.
■■ Show the video segment “Giving Ventilations.”
REFERENCES: ■■ Do not interrupt this skill session to lecture or communicate anything other than
Course guidance related to skill practice. In general, answering questions should occur
Presentation: after the video segment (and skill session) has ended.
Slide 60
Participant’s WATCH-THEN-PRACTICE
Manual:
Chapter 8 ■■ Tell participants that, for this skill, they will watch the video segment without
practicing until you pause it, even though the narration may say to follow along.
■■ Ask participants to take their disposable gloves and resuscitation masks to the
practice area.
■■ Guide participants through the steps of the skill of giving ventilations to an
adult.
GUIDED ■■ Ask participants: What are the differences to be aware of when giving
DISCUSSION: ventilations to a child?
cc When opening a child’s airway, tilt the head slightly past the neutral position,
but not as far as you would for an adult.
cc When giving ventilations to a child, give 1 ventilation about every 3 seconds.
REFERENCES:
Course ■■ Ask participants: What are the differences to be aware of when giving
Presentation: ventilations to an infant?
Participant’s cc Always use a pediatric mask when giving ventilations to an infant.
Manual:
Chapter 8 cc When opening an infant’s airway, keep the head in the neutral position.
cc When giving ventilations to an infant, give 1 ventilation about every 3
seconds.
GIVING VENTILATIONS—INFANT
SKILL ■■ Guide participants through the steps of the skill giving ventilations to an infant.
PRACTICE: Examples of common errors to point out include: not tilting the head, tilting the
■■
head past a neutral position, failing to recheck for breathing and a pulse, giving
ventilations that are too hard or at the wrong rate, not properly sealing the
resuscitation mask, not looking at the chest when checking for breathing, not
using a pediatric mask for the infant victim or not counting out loud.
REFERENCES:
Participant’s
Manual:
Chapter 8

TOPIC: G
IVING VENTILATIONS USING A Time: 15 minutes
BAG-VALVE-MASK RESUSCITATOR
GIVING VENTILATIONS USING A BVM—TWO RESCUERS
ACTIVITY: ■■ Briefly show participants two to three BVMs (adult and infant, child is optional)
and point out the parts (bag, valve and mask), demonstrating how squeezing the
bag opens the one-way valve, forcing air into the lungs, and how releasing the
bag closes the valve, allowing environmental air to refill it.
■■ Emphasize the need for two rescuers: one to position and seal the mask and
REFERENCES: one to squeeze the bag.
Participant’s ■■ Emphasize the need to use the appropriate sized BVM for the victim.
Manual:
Chapter 8
Science Note: Ventilation with a BVM is reserved for when
multiple rescuers are available to treat the victim: One to perform
chest compressions and two others to manage the airway and
provide ventilations. While a BVM may often be used in some
situations by a single responder (advanced medical personnel),
the evidence supports the use of a BVM with two responders:
One to maintain an adequate seal and one to squeeze the bag to
deliver the ventilations.
VIDEO: ■■ Explain to participants that the video segment demonstrates how to use a BVM.
■■ Show the video segment “Using a Bag-Valve-Mask Resuscitator—Two
Rescuers.”
■■ Answer participants’ questions about the segment.
REFERENCES:
Course
Presentation:
Slides 63
Participant’s
Manual:
Chapter 8
GIVING VENTILLATIONS USING A BVM—TWO RESCUERS

SKILL ■■ Divide participants into pairs and guide them through the steps listed on the
PRACTICE: Giving Ventilations Using a Bag-Valve-Mask Resuscitator—Two Rescuers skill
chart.
■■ Guide participants through the steps of the skill for using a BVM on an adult.
REFERENCES: commend correct skill practice.
Participant’s
Manual: ■■ Examples of common errors to point out include: not tilting the head, not
Chapter 8 maintaining a seal with the resuscitation mask, not squeezing the bag hard
enough or squeezing the bag too hard, the chest does not rise, giving
ventilations at the wrong rate, not counting out loud.

TOPIC: AIRWAY OBSTRUCTION Time: 15 minutes
CONSCIOUS CHOKING—ADULT AND CHILD

GUIDED ■■ Ask participants: What is the most common cause of respiratory
DISCUSSION: emergencies?
■■ Answer: Airway obstruction
■■ Ask participants: What are mechanical and anatomical obstructions?
■■ Answers:
REFERENCES: cc Mechanical obstructions result from a foreign body lodged in the airway,
Course generally food or other small objects.

Presentation: cc Anatomical obstructions are caused mostly by the tongue. When a person
Slides 65-66 becomes unconscious, the tongue loses muscle tone and falls back,
Participant’s blocking the airway.
Manual: ■■ If the person cannot cough, speak, cry or breathe, immediate action is needed.
Chapter 8
VIDEO: ■■ Explain to participants that the video segment will demonstrate how to care for
an adult or child who is choking.
■■ Show the video segment “Conscious Choking—Adult and Child.”
■■ Answer participants’ questions about the segments.
REFERENCES:
Course Science Note: Evidence suggests that it may take more
Presentation: than one technique to clear the airway, and that back blows,
Slides 67 abdominal thrusts and chest thrusts are all effective.
Participant’s
Manual:
Chapter 8
SKILL
PRACTICE: Instructor’s Note: Participants need only demonstrate how to
care for conscious choking for an adult. Have participants as a
group explain the differences for a child, such as kneeling if the
victim is shorter.
REFERENCES: ■■ Divide participants into two lines facing the same direction or have them
Participant’s partner and arrange each pair so you can see all groups. Designate victims and
Manual:
Chapter 8 lifeguards.
■■ Instruct participants not to give actual back blows or abdominal thrusts to their
partners.
■■ Guide them through the steps listed on the Conscious Choking—Adult and
Child skill chart.
■■ Have participants change roles and repeat the guided skill practice.
■■ Examples of common errors to point out include: failing to obtain the victim’s
consent, performing abdominal thrusts before back blows, positioning the
hands improperly, not using the thumb side of the fist to give abdominal thrusts.
■■ Remind participants that if a conscious choking victim is too large to reach
around or if the victim is obviously pregnant or known to be pregnant, back
blows and chest thrusts are used.

CONSCIOUS CHOKING—INFANT
VIDEO: ■■ Explain to participants that the video segment will demonstrate how to care for
a choking infant.
■■ Show the video segment “Conscious Choking—Infant.”
■■ Answer participants’ questions about the segments.
REFERENCES:
Course
Presentation:
Slides 68
Participant’s
Manual:
Chapter 8
SKILL ■■ Ask participants to return to the practice area.

PRACTICE: ■■ Divide participants into pairs and guide them through the steps listed on the
Conscious Choking—Infant skill chart.
■■ Guide them through the steps listed on the Conscious Choking—Infant skill
chart.
Participant’s
Chapter 8 ■■ Examples of common errors to point out include: not keeping the infant’s head
lower than the chest, not supporting the head and neck securely when turning
the infant, not placing the fingers correctly for chest thrusts or the hand for back
blows.
ASSIGNMENT
cc Complete eLearning Module 6: Cardiac Emergencies and Using an AED.
cc Read Chapter 9: Cardiac Emergencies in the Lifeguarding Manual.
REFERENCES:
Course
Presentation:
Slides 69

criteria listed at the proficient level to be checked off for this skill. Assessment criteria that are general
for the category of skills, as well as specific to, the skill must be met.
REMOVING DISPOSABLE GLOVES

SKILL CHART: REMOVING DISPOSABLE GLOVES
1. Pinch the glove.
■■ Pinch the palm side of one glove near your wrist.
■■ Carefully pull the glove off so that it is inside out.
2. Slip two fingers under the glove.
■■ Hold the glove in the palm of your gloved hand.
■■ Slip two fingers under the glove at the wrist of the remaining gloved hand.
3. Pull the glove off.
■■ Hold the glove in the palm of your gloved hand.
■■ Slip two fingers under the glove at the wrist of the remaining gloved hand.
4. Dispose of gloves and wash hands.
■■ Dispose of gloves and other PPE in a proper biohazard container.
■■ Wash your hands thoroughly with soap and running water, if available. Otherwise, rub hands
thoroughly with an alcohol-based sanitizer if hands are not visibly soiled.
SKILL ASSESSMENT TOOL: REMOVING DISPOSABLE GLOVES
Removes gloves ■■ Bare skin does not come into ■■ Bare skin comes into contact
contact with outside surface with surface of gloves
of gloves

PRIMARY ASSESSMENT
SKILL CHART: PRIMARY ASSESSMENT—ADULT, CHILD, OR INFANT
Note: Activate the EAP and get an AED on the scene as soon as possible.
1. Size up the scene while forming an initial impression:

■■ Use your senses to check for hazards that could present a danger to you or the victim.
■■ Use appropriate PPE.
■■ Determine the number of injured or ill victims.
■■ Determine what caused the injury or the nature of the illness. Look for clues to what may have
caused the emergency and how the victim became ill or injured.
■■ Form an initial impression that may indicate a life-threatening emergency, including
responsiveness or severe bleeding.
■■ Does the victim look sick? Are they awake and moving?
■■ Determine what additional resources may be needed.
Note: If you see severe life-threatening bleeding, use any available resources to control the bleeding
including a tourniquet if one is available and you are trained.
2. Check for responsiveness.

■■ Shout, “Are you okay?” (use the person’s name if you know it) then tap the victim on the
shoulder and shout, “Are you okay?” again in a shout-tap-shout sequence.
■■ For an infant, tap the foot.
3. If no response, summon EMS personnel, if you have not already done so.
■■ If the victim is face-down, roll the victim onto their back while supporting the head, neck and
back.
4. Perform a primary assessment, open the airway and simultaneously check for breathing and a pulse
for at least 5 seconds, but no more than 10 seconds.
■■ To open the airway:
cc From the side, use the Head-Tilt/Chin-Lift technique.
cc From above the victim’s head, use the jaw-thrust (with head extension) maneuver.
cc If a head, neck or spinal injury is suspected, use the jaw-thrust (without head extension)
maneuver.
■■ Look, listen and feel for breathing and pulse simultaneously.
cc For an adult or child, feel for a carotid pulse by placing two fingers in the middle of the
victim’s throat and then sliding them into the groove at the side of the neck closest to you.
Press lightly.
cc For an infant, feel for the brachial pulse on the inside of the upper arm between the infant’s
elbow and shoulder. Press lightly.

SKILL CHART: PRIMARY ASSESSMENT—ADULT, CHILD, OR INFANT, CONTINUED
5. Give two ventilations ONLY IF the victim is not breathing as the result of a drowning.
■■ If the chest does not clearly rise when attempting either of the first 2 ventilations, re-tilt the head
and try to give another ventilation.
■■ If after the second attempt the chest clearly rises, give 1 more ventilation so there are two
successful ventilations.
■■ If after the second attempt the chest does not clearly rise, immediately give CPR.
■■ Do not attempt giving more than 3 ventilations total.
6. Provide appropriate care.
■■ If the victim is not breathing but has a pulse, give ventilations.
cc Adult: Give 1 ventilation about every 5-6 seconds.
cc Child and Infant: Give 1 ventilation about every 3 seconds.
■■ If the victim is not breathing and has no pulse, begin CPR starting with compressions.
■■ If unresponsive but breathing and you do not suspect a head, neck or spinal injury, place the
victim in a side-lying recovery position. To place the victim in a recovery position:
cc Raise the victim’s arm that is closest to you.
cc Roll the victim toward you so that their head rests on their extended arm.
cc Bend the victim’s knees to stabilize their body.
SKILL ASSESSMENT TOOL: PRIMARY ASSESSMENT—ADULT, CHILD, OR INFANT

Scene size-up ■■ Use of PPE (wears gloves) ■■ Does not use PPE
■■ Obtains consent (child/infant) ■■ Does not obtain consent (child/infant)
Checks for ■■ Uses a shout-tap-shout sequence ■■ Does not check for responsiveness or
responsiveness ■■ Summons EMS personnel use a shout-tap-shout sequence
■■ Does not summons EMS personnel
Simultaneous ■■ Opens and maintains open airway ■■ Does not maintain an open airway
breathing and throughout primary assessment throughout primary assessment
pulse check ■■ Does not look, listen and feel for
breathing and/or pulse
■■ Checks for breathing or pulse for less
than 5 or more than 10 seconds
■■ Checks an incorrect pulse location
■■ Looks, listens and feels for breathing
and pulse for at least 5 seconds but
no more than 10 seconds
■■ For adult or child, feels for carotid
pulse
■■ For infant, feels for brachial pulse
Gives 2 ■■ Gives 2 ventilations that make the ■■ Gives ventilations that do not make
ventilations (for chest clearly rise and last about 1 the chest clearly rise and last 2 or
any victim who second each more seconds each
is unresponsive ■■ Allows the chest to fall between ■■ Does not give ventilations
as a result of a ventilations ■■ Gives fewer or more than 2
drowning) ventilations
■■ Does not allow chest to fall between
ventilations

RECOVERY POSITIONS
SKILL CHART: SIDE-LYING RECOVERY POSITION
1. Kneel at the victim’s side.
2. Extend the victim’s arm that is closest to you above the victim’s head.
3. Roll the victim toward you so that they are on their side. The victim’s head should rest on their
extended arm.
4. Bend both of the victim’s knees to stabilize their body.
Note: Use a side-lying recovery position when a victim is responsive and breathing and you do not
suspect a head, neck or spinal injury. You should also use this recovery position if you have to leave
for any reason, such as to get help, even if the victim has a head, neck or spinal injury.
SKILL CHART: INFANT RECOVERY POSITION (ALTERNATE)

1. Carefully position the infant face-down along your forearm.
2. Support the infant’s head and neck with your other hand while keeping the infant’s mouth and nose
clear.
SKILL ASSESSMENT TOOL: RECOVERY POSITIONS
SIDE-LYING RECOVERY POSITION
Maintains an open airway ■■ Rolls victim onto side ■■ Victim is vomiting but left
lying face-up
Support head, neck and spine ■■ Rolls victim in a smooth motion ■■ Lifts or pushes the head or
until on their side neck
INFANT (ALTERNATE)
Maintains an open airway ■■ Mouth and nose are clear ■■ Infant’s mouth or nose is
blocked by forearm or hand
Supports head and neck ■■ Infant face-down along the ■■ Infant’s head or body is
rescuer’s forearm sideways or dangling from
■■ Head and neck supported by forearm
other hand

USING A RESUSCITATION MASK
SKILL CHART: HEAD-TILT/CHIN-LIFT TECHNIQUE
1. Kneel to the side of the victim’s head.
2. Position the mask.
■■ Place the rim of the mask between the victim’s lower lip and chin.
■■ Lower the mask until it covers the victim’s mouth and nose.
3. Seal the mask.
■■ Place the thumb and fingers of one hand around the top of the mask.
■■ Place the thumb of your other hand on the bottom of the mask and slide your first two fingers
onto the bony part of the victim’s chin.
■■ Press downward on the mask with your top hand and the thumb of your lower hand to seal the
top and bottom of the mask.
4. Tilt the victim’s head back and lift the chin to open the airway.
5. Blow into the mask.
■■ Each ventilation should last about 1 second and make the chest clearly rise. The chest should
fall before the next ventilation is given.
SKILL CHART: JAW-THRUST (WITH HEAD EXTENSTION) MANEUVER
■■ Kneel above the victim’s head.
■■ Place the rim of the mask between the lower lip and chin.
■■ Lower the resuscitation mask until it covers the victim’s mouth and nose.
2. To seal the mask and open the airway:
■■ Using the elbows for support, place your thumbs and index fingers along each side of the
resuscitation mask to create a “C.”
■■ Slide your 3rd, 4th and 5th fingers into position to create an “E” on both sides of the victim’s
jawbone.
■■ Hold the mask in place while you tilt the head back and lift the jaw into the mask.
SKILL CHART: JAW-THRUST (WITHOUT HEAD EXTENSTION) MANEUVER

■■ Kneel above the victim’s head.
■■ Place the rim of the mask between the lower lip and chin.
■■ Lower the resuscitation mask until it covers the victim’s mouth and nose.
2. To seal the mask and open the airway:
■■ Place your thumbs and index fingers along each side of the resuscitation mask to create a “C.”
■■ Slide your 3rd, 4th and 5th fingers into position to create an “E” on both sides of the victim’s
jawbone.
■■ Without moving or tilting the head back, lift the lower jaw up with your fingers along the jawbone
to seal the mask to the face.
3. Blow into the mask.
fall before the next ventilation is given.

SKILL ASSESSMENT TOOL: USING A RESUSCITATION MASK
Open the airway: ■■ Tilts the head back so that the ■■ Tilts head back so that jaw
■■ Head-tilt/chin-lift or jaw line is at an angle of 80° to line is at an angle less than
jaw thrust (with head 100° to the floor 80° or greater than 100° to
extension) maneuver the floor
■■ Jaw thrust (without head ■■ Lifts the victim’s jaw to open ■■ Tilts the victim’s head back
extension) maneuver the airway
■■ Give ventilations ■■ Gives ventilations that make ■■ Ventilations do not make the
the chest clearly rise and last chest clearly rise
about 1 second each ■■ Ventilation lasts 2 or more
seconds
GIVING VENTILATIONS USING A BAG-VALVE-MASK RESUSCITATOR
SKILL CHART: GIVING VENTILATIONS USING A BAG-VALVE-MASK RESUSCITATOR—TWO
RESCUERS
1. Rescuer 1 kneels behind the victim’s head and positions the mask over the victim’s mouth and
nose.
2. Rescuer 1 seals the mask.
3. Rescuer 1 opens the airway using the jaw-thrust (with head extension) maneuver.
4. Rescuer 2 gives ventilations.
■■ Squeeze the bag slowly with both hands.
■■ For an adult, give 1 ventilation about every 5-6 seconds.
■■ For a child or infant, give 1 ventilation about every 3 seconds.
fall before the next breath is given.
5. Rescuer 2 rechecks for breathing and a pulse about every 2 minutes.
■■ Remove the mask and look, listen and feel for breathing and a pulse for at least 5, but no more
than 10 seconds.
SKILL ASSESSMENT TOOL: GIVING VENTILATIONS USING A BVM—TWO RESCUERS
Opens airway ■■ Performs a jaw-thrust (with ■■ Tilts the head from the side
head extension) maneuver ■■ Unable to open the airway
Delivers the appropriate ■■ Squeezes the bag to give ■■ Victim’s chest does not rise
volume of air with each ventilations that make the chest
ventilation
Gives ventilations at the ■■ Adult ratio: Squeezes the bag ■■ Gives ventilations too slow or
correct ratio for the victim to give 1 ventilation about too fast
every 5-6 seconds ■■ Gives ventilations at an
inappropriate rate
Gives ventilations at the ■■ Child or Infant ratio: Squeezes ■■ Gives ventilations too slow or
correct ratio for the victim the bag to give 1 ventilation too fast
about every 3 seconds ■■ Gives ventilations at an
inappropriate rate

AIRWAY OBSTRUCTION
SKILL CHART: CONSCIOUS CHOKING—ADULT AND CHILD
If the victim cannot cough, speak or breathe:
1. Give 5 back blows.
■■ Position yourself slightly behind the victim.
■■ Place one arm diagonally across the victim’s chest and bend the victim forward at the waist. The
victim’s upper airway should be at least parallel to the ground.
■■ Firmly strike the victim between the shoulder blades with the heel of your hand.
■■ Each thrust should be a distinct attempt to dislodge the object.
2. Give 5 abdominal thrusts.
■■ Stand behind the victim.
■■ For a child, stand or kneel behind the child, depending on the child’s size. Use less force on a
child than you would on an adult.
■■ Place the thumb side of your fist against the middle of the abdomen, just above the navel.
■■ Grab your fist and give quick, upward thrusts.
■■ Each thrust should be a distinct attempt to dislodge the object.
SKILL ASSESSMENT TOOL: CONSCIOUS CHOKING—ADULT OR CHILD

Bends the person forward at ■■ Positions person with upper ■■ Positions person with upper
the waist for back blows airway (person’s head and airway (person’s head and
neck) parallel to the ground or neck) angled upward
angled slightly downward
Gives 5 back blows ■■ Strikes the back with heel of ■■ Strikes the back with closed
one hand hand
■■ Strikes the center of the back ■■ Strikes the back with palm
between shoulder blades ■■ Strikes the back more than 2
■■ Each back blow is a separate inches from the center of both
and distinct attempt to shoulder blades
dislodge the object ■■ Each back blow is not a
separate and distinct attempt
to dislodge the object
Gives 5 abdominal thrusts ■■ Places fist within 2 inches of ■■ Places fist more than 2 inches
navel from navel
■■ Places fist 1 inch or more away ■■ Places fist less than 1
from lower tip of breastbone inch from the lower tip of
■■ Each abdominal thrust is a breastbone (too close to
separate and distinct attempt breastbone)
to dislodge the object ■■ Each abdominal thrust is not a
separate and distinct attempt
to dislodge the object

SKILL CHART: CONSCIOUS CHOKING—INFANT
If the victim cannot cough, speak or breathe:
1. Carefully position the infant face-down along your forearm.
■■ Support the infant’s head and neck with your hand.
■■ Lower the infant onto your thigh, keeping the infant’s head lower than their chest.
2. Give 5 back blows.
■■ Give back blows with the heel of your hand between the infant’s shoulder blades.
■■ Each back blow should be a distinct attempt to dislodge the object.
3. Position the infant face-up along your forearm.
■■ Position the infant between both of your forearms, supporting the infant’s head and neck.
■■ Turn the infant face-up.
■■ Lower the infant onto your thigh with the infant’s head lower than their chest.
4. Give 5 chest thrusts.
■■ Put two or three fingers on the center of the chest just below the nipple line and compress the
chest about 1½ inches.
■■ Each chest thrust should be a distinct attempt to dislodge the object.
SKILL ASSESSMENT TOOL: CONSCIOUS CHOKING—INFANT

Keeps the head lower than ■■ Positions infant with upper ■■ Positions infant with upper
the chest airway (infant’s head and neck) airway (infant’s head and
angled downward, lower than neck) parallel to ground or
chest angled upward
Supports the head and neck ■■ Places thumb and fingers on ■■ Places thumb on front of
securely infant’s jaw infant’s neck
■■ Places fingers on front of
infant’s neck
Maintains firm support ■■ Holds infant securely ■■ Drops infant
■■ Loses control of infant
Gives back blows ■■ Strikes the back with the heel ■■ Strikes the back with a closed
of one hand hand
■■ Strikes the center of the back ■■ Strikes the back with a palm
between the shoulder blades ■■ Strikes the back more than 1
inch from the center of both
shoulder blades
Gives chest thrusts ■■ Places fingers in line with the ■■ Places fingers perpendicular
breastbone (not to breastbone
across/perpendicular to the ■■ Places fingers outside center
breastbone) of chest
■■ Places fingers in center of ■■ Places fingers more than 1
chest not more than 1 inch inch below nipple line
below nipple line ■■ Places fingers more than 1
inch above nipple line

LESSON 6
CARDIAC EMERGENCIES AND USING AN
AUTOMATED EXTERNAL DEFIBRILLATOR

■■ Discuss all points in the topic Cardiac Arrest.
■■ Guide the discussion on CPR.
■■ Show the video segment and complete the skill practice for CPR—Adult and Child.
■■ Show the video segment and complete the skill practice for CPR—Infant.
■■ Discuss all points in the topic Two-Rescuer CPR.
■■ Complete the skill practice Two-Rescuer CPR—Adult and Child.
■■ Guide the discussion on Two-Rescuer CPR—Infant.
■■ Complete the skill practice Two-Rescuer CPR—Infant.
■■ Discuss all points in the topic When the Heart Stops and AEDs.
■■ Discuss all points in the topic Using an AED.
■■ Complete the skill practice for Using an AED.
■■ Discuss all points in the topic AED Precautions and AED Maintenance.
■■ Complete the activity Using an AED in Unique Situations—Fact or Fiction.
■■ Discuss all points in the topic CPR with Airway Obstruction.
■■ Complete the skill practice for CPR—Obstructed Airway.
■■ Show the video segment “Putting It All Together—Multiple-Rescuer Response.”
■■ Conduct the skill drills for Multiple-Rescuer Response.
■■ Conduct the Putting It All Together skill drills.
■■ Complete the Lifeguard Station Response Time Testing skill drills.
cc Recognizing and Caring for a Heart Attack
cc CPR
cc Using an AED
cc CPR with Airway Obstructions

LESSON OBJECTIVES
■■ Identify the five links in the Adult and Pediatric Cardiac Chain of Survival and identify the
importance of each.
■■ Recognize the signs and symptoms of a heart attack.
■■ Identify the steps for caring for a victim of a heart attack.
■■ Identify signs and symptoms of cardiac arrest.
■■ Demonstrate how to safely and effectively perform one-rescuer CPR, two-rescuer CPR and
multiple-rescuer response.
■■ Demonstrate how to use an automated external defibrillator (AED).
■■ Identify precautions for using an AED.
■■ Demonstrate how to perform a water rescue, extricate and provide the appropriate care in a
multiple-rescuer response utilizing the AED and BVM.

■■ Manikins (one adult and one infant manikin for every two participants, child manikins optional)
■■ Pediatric resuscitation masks (one per participant)
■■ Automated External Defibrillator (AED) training devices (one for every two participants)
■■ AED training pads (one set of adult and one set of pediatric training pads for every two
participants)
■■ Backboard (one for every three participants)
■■ Timing device such as a stop watch or smartphone with a stop watch feature (one per
instructor)
■■ Adult and Pediatric bag-valve-mask (BVM) resuscitators
■■ Hip packs (one for each participant)
■■ Multiple-Rescuer Response Scenario Assessment Forms
LESSON PREPARATION
■■ To save time, have all equipment and supplies prepared and available ahead of time. Each
group of five participants needs one set of equipment for the multiple-rescuer response
scenarios.
■■ Be prepared to answer questions participants may have about the eLearning content and
review questions they completed.
■■ Have copies of the appropriate materials ready before the start of class.
cc Copy the appropriate number of the Multiple-Rescuer Response Scenario Assessment
Tools.

INSTRUCTOR NOTES
completion certificates they received when they completed eLearning Module 6: Cardiac
Emergencies and Using an AED.
■■ Choose either the practice-while-you-watch or watch-then-practice method for the CPR skill
practices.
■■ Participants need only demonstrate adult CPR and be able to point out how it differs from
performing CPR on a child, such as compressing the chest to a depth less than that for an
adult.
■■ Participants only need to demonstrate either adult two-rescuer CPR or child two-rescuer CPR
and be able to point out how one differs from the other, such as depth of compressions and
ratio of compressions to ventilations.
■■ Participants only need to demonstrate how to use an AED on either an adult, a child or an infant
and be able to point out the differences in the use of an AED for the other two age groups.
■■ Participants only need to demonstrate CPR—Obstructed Airway on an adult and infant and be
able to point out the differences in technique for a child.
■■ The purpose of the multiple-rescuer response drill is for participants to apply all the skills they
have learned thus far about water rescues and CPR and gain experience in using decision-
making skills, communicating with other group members in prioritizing care steps, and working
together to provide CPR with BVM and AED after a water rescuer and extrication.
■■ During the multiple-rescuer response skill drill:
cc Assign the rescuing lifeguard (and assisting responder when specified in the scenario),
but do not assign roles to additional responders. Instead allow them to prioritize and take
action. For example, the first rescuer on the scene with gloves on should start the care
step immediately, not wait for the other responder(s) to get ready. The responders must
communicate and move into position to start the care step that should occur. The intent
of the drill is to help participants apply their knowledge and decision-making skills while
working as a team.
■■ See a video example about how to conduct a multiple-rescuer response drill on the Red Cross
Learning Center.
■■ The final skills scenario will include Multiple-Rescuer Response Scenario 3.
TEACHING TIPS
practice.
■■ Arrange the manikins so the heads are facing the same direction to make it easier for you to
observe and assess participant performance.
■■ When using the practice-while-you-watch method, do not interrupt this skill session to lecture
or communicate anything other than guidance related to skill practice. In general, answering
questions should occur after the video segment (and skill session) has ended.
■■ When practicing using the AED, guide participants through the skill without each group turning
on their AED units so your unit is the only one audible. Once you have led them through the skill
initially, have the groups repeat with their units turned on so they can follow the audible prompts
of their unit(s). Ensure they turn the volume of each unit to a level their group can hear but not
so loud as to disrupt other groups also trying to hear their unit.
■■ When practicing in-water skill drills, stagger the groups in a way that allows you to observe and
give feedback of the groups and maximize practice time for all participants rather than having
them watch another group (if you have enough participants in the class).
■■ For the multiple-rescuer response scenarios, ensure that participants are getting in the
appropriate positions, changing positions for the skill they are performing and are allowing for
a quick and effective change in position (i.e., not stepping over the victim, etc.). If you notice
some participants acting unsure, help them and rotate them into positions in other scenarios
that will require them to lead and demonstrate their skill and knowledge.

TOPIC: CARDIAC ARREST Time: 5 minutes
CARDIAC ARREST
LECTURE ■■ Ask participants: What are some signs of cardiac arrest?
AND GUIDED Answers: Responses should include the following:
DISCUSSION: cc Sudden collapse
cc Unconsciousness
cc Absence of breathing
cc Absence of a pulse
REFERENCES: ■■ Ask participants: What is the difference between a heart attack and
Course cardiac arrest?
Presentation:
cc A heart attack occurs when the heart muscle experiences a loss of
Participant’s
Manual: oxygenated blood.
Chapter 9 cc Cardiac arrest occurs when the heart stops beating or the heart is beating
too irregularly or too weakly to circulate blood effectively. The victim is
unresponsive, is not breathing normally and does not have a pulse. A heart
attack may cause cardiac arrest.

TOPIC: CPR Time: 40 minutes
CPR
LECTURE ■■ Ask participants: What is CPR?
AND GUIDED Answer: CPR is a combination of chest compressions and ventilations to
DISCUSSION: circulate blood that contains oxygen to the brain and other vital organs of a
person whose heart and breathing have stopped.
■■ Ask participants: How can you make sure that your chest compressions
are effective?
Course cc Placing the victim on a firm, flat surface
Presentation: cc Correctly positioning the hands for compressions
Slides 75–78
cc Compressing the chest in a straight-down manner to the proper depth
Participant’s
cc Performing compressions at the proper rate
Manual:
Chapter 9 cc Making sure the chest is exposed to ensure that the chest recoils between
each compression
cc Minimizing interruptions in CPR
■■ Ask participants: Once started, do not stop CPR except in which of
these situations?
cc You notice an obvious sign of life, such as normal breathing.
cc An AED is ready to analyze the victim’s heart rhythm.
cc Another trained responder or EMS personnel takes over.
cc You are alone and too exhausted to continue.
cc The scene becomes unsafe.
■■ Ask participants: What should you do if, at any time, you notice normal
breathing?
cc Stop CPR and continue to monitor the victim’s condition. Be prepared to
resume care if necessary.
Science Note:
■■ Chest Compressions: Actual depth may be difficult to
judge without the use of feedback devices, but it is critical to
compress the chest AT LEAST 2 inches for an adult victim.
Evidence shows that compression depths greater than 2.4
inches in the average adult lead to a higher incidence of non-
life threatening injuries and should be avoided. Compression
rates that exceed 120 compressions per minute also affect
the quality of compressions. Evidence suggests that higher
rates of compressions lead to inadequate compression depths.
■■ High Performance CPR: Evidence continues to build that
the key to successful resuscitations is the delivery of high
quality CPR, including uninterrupted chest compressions and
ventilations.
■■ CPR differences—Adult and Child: The majority of
pediatric cardiac arrests are a result of a respiratory cause
such as a breathing problem (asthma/anaphylaxis), an
obstructed airway, drowning or an injury. As such, ventilations
and appropriate oxygenation are important for a successful
resuscitation. In these situations, laryngeal spasm may
occur, making passive ventilation during chest compressions
minimal or non-existent.

CPR—ADULT AND CHILD
SKILL ■■ Choose either the practice-while-you-watch or watch-then-practice method for
PRACTICE: this skill practice.
■■ Participants need only demonstrate adult CPR and be able to point out how
it differs from performing CPR on a child, such as compressing the chest to a
depth less than that for an adult.
Participant’s
Chapter 9 ■■ Examples of common errors to point out include: compressions that are too
shallow or too deep, interrupting compressions for too long or too frequently,
incorrect hand position, failure to allow full recoil after each compression or
inappropriate rate (speed) of compressions, incorrect rate of compressions and
ventilations, inadequate ventilations, not counting out loud.
SKILL PRACTICE-WHILE-YOU-WATCH
PRACTICE:
practice area.
■■ Explain to the participants that, for this skill, they will follow along with and
practice the steps for performing CPR as they are guided by the video segment.
REFERENCES: ■■ Show the video segment “CPR—Adult and Child.”
Course ■■ Do not interrupt this skill session to lecture or communicate anything other than
Presentation:
Slide 79 guidance related to skill practice. In general, answering questions should occur
after the video segment (and skill session) has ended.
Participant’s
Manual:
Chapter 9 WATCH-THEN-PRACTICE
■■ Tell participants that, for this segment, they will watch the video segment
without practicing until you pause it, even though the narration may say to follow
along.
■■ Show the video segment “CPR—Adult and Child.”
practice area.
■■ Guide participants through the steps of the skill and evaluate completion of the
skill using the skill chart.

CPR—INFANT
VIDEO ■■ If using the practice-while-you-watch method, move to the skill practice and
SEGMENT: show the video segment as you conduct the skill practice.
■■ Explain to participants that the video segment will demonstrate the procedures
for one-rescuer CPR for an infant.
■■ Show the video segment “CPR—Infant.”
REFERENCES: ■■ Answer participants’ questions about the video segment.
Course
Presentation:
Slide 80
Participant’s
Manual:
Chapter 9
SKILL ■■ Follow the same steps as in the previous skill practice:

PRACTICE: cc Have participants practice the skill.
cc Observe each participant’s performance of the skill and provide global and
cc Examples of common errors to point out include: compressions that are too
REFERENCES:
shallow or too deep, interrupting compressions for too long or too frequently,
Participant’s
Manual: incorrect finger position and failure to allow full recoil after each compression,
Chapter 9 inappropriate rate (speed) of compressions, incorrect rate of compressions
and ventilations, inadequate ventilations or not counting out loud.

TOPIC: T
WO-RESCUER CPR— Time: 15 minutes
ADULT AND CHILD
TWO-RESCUER CPR
LECTURE ■■ Ask participants: What is two-rescuer CPR?
AND GUIDED Answer: Two-rescuer CPR is when one rescuer gives ventillations while the
DISCUSSION: other performs chest compressions.
■■ Ask participants: How often should you switch positions?
Answer: Rescuers switch positions about every 2 minutes.
■■ When CPR is in progress by one rescuer and a second rescuer arrives,
the second rescuer should confirm whether EMS personnel have been
REFERENCES: summoned. If not, the second rescuer does so before getting the AED
Course or assisting with care.
Presentation:
Slides 82–84
Participant’s
Manual:
Chapter 9
TWO-RESCUER CPR—ADULT AND CHILD

SKILL ■■ Ask participants: What questions do you have about the “Two-Rescuer
PRACTICE: CPR—Adult and Child” video?
■■ Pair up participants and, using a manikin and a resuscitation mask, conduct the
skill practice.
■■ Participants only need to demonstrate either adult two-rescuer CPR or child
two-rescuer CPR and be able to point out how one differs from the other, such
REFERENCES: as depth of compressions and ratio of compressions to ventilations.
Course
Presentation: ■■ Guide participants through the steps of the skill.
Slides 85 ■■ Observe each participant’s performance of the skill and provide global and
Participant’s individual feedback during skill practice to correct common mistakes or
Chapter 9 ■■ Examples of common errors to point out include: compressions that are
too shallow or at an inappropriate rate, compressing and ventilating at the
same time, failing to call for a position change or using an incorrect cycle of
compressions and ventilations.
TWO-RESCUER CPR—INFANT
SKILL ■■ Ask participants: What questions do you have about the “Two-Rescuer
PRACTICE: CPR—Infant” video?
■■ Pair up participants and, using a manikin and a resuscitation mask, conduct the
skill practice.
■■ Guide participants through the steps of the skill.
Course
Presentation: commend correct skill practice.
Slides 85 ■■ Examples of common errors to point out include: compressions that are
Participant’s too shallow or at an inappropriate rate, compressing and ventilating at the
Manual: same time, failing to call for a position change, or using an incorrect cycle of
Chapter 9 compressions and ventilations.

TOPIC: WHEN THE HEART STOPS Time: 5 minutes
WHEN THE HEART STOPS

LECTURE ■■ Ask participants: What are the two most common treatable abnormal
AND GUIDED rhythms associated with sudden cardiac arrest?
DISCUSSION: Answer: Ventricular fibrillation (V-fib) and ventricular tachycardia (V-tach).
■■ Ask participants: What is an AED?
Answer: An AED is a portable electronic device that analyzes the heart’s
rhythm and provides an electrical shock.
■■ Each minute that CPR and defibrillation are delayed, the victim’s
REFERENCES: chance for survival is reduced by about 10 percent.
Course
Presentation:
Slide 87-89
Participant’s
Manual:
Chapter 9
TOPIC: U SING AN AED Time: 10 minutes
USING AN AED
LECTURE ■■ When cardiac arrest occurs, use an AED as soon as it is ready to use.
POINTS: ■■ If the AED advises that a shock is needed, follow protocols to provide
1 shock followed by about 2 minutes of CPR.
■■ If CPR is in progress, do not interrupt chest compressions until the
AED is turned on, the AED pads are applied and the AED is ready to
analyze the heart rhythm.
REFERENCES:
■■ AEDs may be equipped with pediatric AED pads; however, pediatric
Course
Presentation: pads are appropriate only for use on infants and children up to 8 years
Slides 91–92 of age or weighing less than 55 pounds.
Participant’s cc If pediatric-specific equipment is not available and local protocols
Manual: allow, you can use an AED designed for adults.
Chapter 9 cc If the AED pads risk touching each other because of the smaller
chest size, use the anterior (front)/posterior (back) method of pad
placement.
Science Note:
■■ For every 1 minute of delayed defibrillation, the rate of
survival drops 7 to 10 percent.
■■ AEDs allow for compressions post-analysis while the AED is
charging. Lifeguards and professional rescuers may perform
compressions from the time the shock advised prompt is
noted through the time that the prompt to clear occurs, just
prior to depressing the shock button. Emphasize the need to
follow the manufacturer’s recommendations and their local
protocols and practices.

SKILL ■■ Ask participants: What questions do you have about the video “Using an
PRACTICE: AED”?
■■ Using manikins, resuscitation masks and training AEDs with the appropriately
sized AED training pads, have participants work in pairs with their AED skill
sheets to lead each other as they practice the skill.
■■ Participants only need to demonstrate how to use an AED on either an adult, a
REFERENCES: child or an infant and be able to point out the differences in the use of an AED
Course for the other two age groups.
Presentation:
Slides 93 ■■ Observe each participant’s performance of the skill and provide global and
Participant’s
Chapter 9 ■■ Examples of common errors to point out include: not wiping the victim’s chest,
using pediatric AED pads on an adult, failing to resume CPR after delivery of a
shock or incorrect CPR performance.
USING AN AED—CPR IN PROGRESS

LECTURE ■■ Ask participants: What questions do you have about the “Using an
POINTS: AED—CPR in Process” video?
■■ When one rescuer is on the scene, that rescuer begins CPR and
instructs someone to summon EMS personnel and obtain the AED, if
one is available.
■■ When the assisting rescuer arrives, they prepare the AED for use while
REFERENCES: the rescuing lifeguard continues CPR.
Course
Presentation: ■■ If at any time either rescuer notices an obvious sign of life, such as
Slide 95-96 normal breathing, they should stop CPR and monitor the victim’s
Participant’s
condition and administer emergency oxygen, if it is available and
Manual: rescuers are trained.
Chapter 9 ■■ Explain to participants that they will practice using an AED while CPR is in
progress at multiple times later in the course.

TOPIC: CPR WITH AIRWAY OBSTRUCTION Time: 10 minutes
CPR WITH AIRWAY OBSTRUCTION

LECTURE ■■ If a victim who is choking becomes unresponsive, carefully lower
POINTS: them to a firm, flat surface, send someone to get an AED, and
summon EMS if you have not already done so.
■■ Immediately begin CPR starting with chest compressions.
■■ As you open the airway to give ventilations, look in the person’s
mouth for any visible object.
REFERENCES:
■■ If you can see it, use a finger sweep motion to remove it. If you don’t
Course
Presentation: see the object, do not perform a blind finger sweep, but continue CPR.
Slide 98
Participant’s
Manual:
Chapter 9
SKILL ■■ Ask participants: What questions do you have about the “CPR—
PRACTICE: Obstructed Airway” video?
■■ Using manikins and resuscitation masks, have participants work in pairs using
their CPR—Obstructed Airway skill sheets to lead each other as they practice
the skill.
■■ Participants only need to demonstrate CPR—Obstructed airway on an adult
REFERENCES: and infant and be able to point out the differences in technique.
Course
Presentation: ■■ Observe each participant’s performance of the skill and provide global and
Slide 99 individual feedback during skill practice to correct common mistakes or
Participant’s
Manual: ■■ Examples of common errors to point out include: using abdominal thrusts
Chapter 9 instead of chest compressions, failing to check the mouth for an object,
performing a blind finger sweep, compressing too little or too much, failing to
give ventilations, using the wrong finger to clear the object from the mouth or
incorrect compression to ventilation ratio, not counting out loud.

TOPIC: I N-WATER SKILL SESSION: Time: 45 minutes
PUTTING IT ALL TOGETHER
RESCUE, EXTRICATION, PRIMARY ASSESSMENT AND BVM
SKILL DRILL:
Instructor’s Note: The purpose of this skill drill is for
participants to gain experience with a scenario that includes a
water rescue, extrication and providing ventilations using a BVM.
Part 2 of the drill challenges participants to perform the scenario
within 1½ minutes.
■■ Assemble the participants on the pool deck and explain they will be practicing
team rescues for a submerged passive victim in deep water, extricating the
victim from the water on a backboard, performing a primary assessment and
providing care for a victim who is not breathing but has a pulse.

■■ For the Shallow Water Lifeguarding course, participants will practice rescuing a
submerged passive victim in shallow water.
■■ Divide the participants into groups of three and assign one rescuing lifeguard,
one assisting responder and one victim for each group. Have each lifeguard
and assisting responder wear a hip pack containing gloves and a resuscitation
mask.
■■ Have a manikin available to substitute into the drill once the rescue and
extrication are complete.
■■ Explain that for each group:
cc The rescuing lifeguard will simulate activating the EAP and enter the water.
cc The victim will get into position and submerge as the rescuing lifeguard gets
near. The rescuing lifeguard will perform a submerged passive victim rescue.
cc The assisting lifeguard will bring the backboard and assist the rescuing
lifeguard in extricating the victim, demonstrating team communication skills
between the lifeguards.
cc Once removed from the water, the lifeguards should do a primary
assessment on a manikin, give 2 ventilations and then provide care for a
victim who is not breathing but has a pulse. The lifeguards should give
ventilations using a BVM.
■■ Repeat the drill until each person in the group has performed as a rescuing
lifeguard and an assisting responder.

LIFEGUARD STATION RESPONSE TIME TESTING
SKILL DRILL:
Instructor’s Note: The purpose of this drill is to test response
time, not victim recognition. Participants will know who the victim
is and where they are positioned. This test is designed to assist
supervisors at a facility and to evaluate each zone by getting
REFERENCES: an average time for different lifeguards, not to test individual
Course lifeguard performance.
Presentation:
Slide 101
■■ Assemble participants on the pool deck and explain they will be practicing
lifeguard station response time testing.
■■ This drill helps managers evaluate the ability of a lifeguard to reach a victim from
anywhere in a zone and to rescue a submerged, passive victim, extricate and
provide 2 ventilations.
■■ Explain to participants that the goal of this drill is not to exceed 1½ minutes
from any location within that zone, including the furthest and deepest spot.
■■ Divide participants into groups of three and assign one rescuing lifeguard, one
assisting responder and one victim for each group. Have each lifeguard and
assisting responder wear a hip pack containing gloves and a resuscitation
mask.
■■ Have a manikin available to substitute into the drill once the primary assessment
is complete.
■■ Place the lifeguard at a “station” and the assisting responder where they would
normally be within the facility, such as in a break room or location as a back-up
responder.
Instructor’s Note: A mock station can be used if an actual

station is not available.
■■ Initiate the drill:

cc Place the “victim” in the pre-arranged location (for example a submerged
victim in the farthest corner of the zone). The zones should be a realistic
size and shape. The victim should not submerge until the lifeguard nears the
scene.
cc Start the drill by having the lifeguard activate the EAP.
■■ Time the response. Start timing at the whistle blast/EAP signal and stop when
the victim has been extricated from the water and 2 ventilations have been
given.
■■ Ask participants: What adjustments could be made to reduce the time, if
needed, and ensure that lifeguards at each zone are able to respond,
extricate and begin ventilations?
cc Moving the lifeguard station
cc Adjusting the zone coverage, such as splitting the zone
cc Adjusting the placement of emergency equipment or emergency back-up

personnel

TOPIC: PUTTING IT ALL TOGETHER: Time: 1 hour, 5 minutes
MULTIPLE-RESCUER RESPONSE
MULTIPLE-RESCUER RESPONSE
VIDEO ■■ Explain to participants that the video segment will demonstrate the procedures
SEGMENT: for a multiple-rescuer response with CPR in progress.
■■ Show the video segment “Putting It All Together—Multiple-Rescuer Response.”
■■ Answer participant’s questions about the segment.
REFERENCES:
Course
Presentation:
Slide 102
SKILL DRILL—MULTIPLE-RESCUER RESPONSE

SKILL DRILL:
Instructor’s Note: The purpose of this drill is for participants
to apply all the skills they have learned thus far about water
rescues and CPR and to gain experience in using decision-
REFERENCES:
making skills, communicating with other group members in
prioritizing care steps and working together to provide CPR with
Participant’s
Manual: BVM and AED after a water rescuer and extrication.
Chapter 9
■■ Assemble the participants on the deck and explain that they will now put their
multiple-rescuer response skills into practice.
■■ Explain that they will begin with practice of multiple-rescuer scenarios for a
victim on land (Scenarios 1 and 2) and then will practice scenarios that include
a completion of a water rescue (Scenarios 3 and 4).
■■ Use the Scenario Flow Sheets in Appendix B to conduct the multiple-rescuer
response scenarios and use the Multiple-Rescuer Response Assessment Tools
in Appendix F to evaluate the individual and team performance.
■■ For all scenarios, ensure that all lifeguards are equipped with hip packs
containing gloves and resuscitation masks and each team is equipped with a
BVM and AED training unit. For scenarios 3 and 4, have a manikin available to
substitute for the victim after the victim is extricated from the water. The victim
for the water rescue should be submerged in deep water.
■■ For scenario 1:
cc Divide participants into groups of four and assign two lifeguards as the first
responders on the scene and two lifeguards as the additional responders
that will arrive when prompted with the BVM and AED.
cc Divide participants into groups of four and assign four lifeguards that
will all arrive on the scene at the same time. This scenario assumes the
water rescue has already been completed and the scenario starts on land.
Consent is implied for the drowning victim.
cc Divide participants into groups of five and assign one victim and two
lifeguards as the first responders on the scene (one rescuing lifeguard and
one assisting lifeguard to assist with extrication) and two lifeguards as the
additional responders that will arrive when prompted with the BVM and AED.
Substitute a manikin for the victim after the victim has been extricated from
the water.

SKILL DRILL: ■■ For scenario 4:
continued cc Divide participants into groups of five and assign one victim and four
lifeguards as the first responders on the scene (one rescuing lifeguard, one
assisting lifeguard to assist with extrication and two lifeguards to bring the
BVM and AED). Consent is implied for the drowning victim.
■■ Conduct scenarios 1, 2, 3 and 4. Ensure that each participant in the class has
acted as the rescuing lifeguard at least once in scenarios 3 and 4. The intent
is for participants to apply what they are learning through the class and gain
experience in various roles.
Instructor’s Note:
■■ Assign the rescuing lifeguard (and assisting responder when
specified in the scenario), but do not assign roles to additional
responders. For example: bring the AED, bring the BVM, etc. The
intent is to help participants apply their knowledge and decision-
making skills while working as a team.
■■ See a video example of one of these drills on the Red Cross
Learning Center.
■■ The final skills scenario will include Multiple-Rescuer Response
Scenario 3.
ASSIGNMENT
cc Complete eLearning Module 7: First Aid.
cc Read Chapter 10: First Aid in the Lifeguarding Manual.
REFERENCES:
Course
Presentation:
Slide 103

for the category of skills, as well as specific to the skill, must be met.
CPR
SKILL CHART: CPR—ADULT, CHILD AND INFANT
If the victim is not breathing and has no pulse:
1. Give 30 chest compressions.
■■ Adult or Child: Place the heel of one hand in the center of the chest on the lower half of sternum
with the other hand on top.
cc Keep your arms as straight as possible and shoulders directly over your hands.
■■ Infant: Place one hand on the infant’s forehead. Place two or three fingers from your hand
closest to the infant’s feet on the center of the chest just below the nipple line. The fingers
should be oriented so they are parallel not perpendicular to the sternum.
■■ Push hard, push fast.
cc Compress the chest at a depth of:
●● Adult: At least 2 inches but not more than 2.4 inches
●● Child: About 2 inches
●● Infant: About 1½ inches
cc Compress the chest at a rate of at least 100 per minute but no more than 120 per minute.
●● Let the chest fully recoil between each compression.
●● Give 2 ventilations.
2. Give 2 ventilations.
3. Perform cycles of 30 compressions and 2 ventilations.
Continue CPR until:
■■ You see an obvious sign of life, such as normal breathing or victim movement.
■■ An AED is ready to analyze the victim’s heart rhythm.
■■ Another trained responder or responders take over, such as a member of your safety team or
EMS personnel, and relieve you from giving compressions or ventilations.
■■ You are alone and too exhausted to continue.
■■ The scene becomes unsafe.
SKILL ASSESSMENT TOOL: CPR—ADULT OR CHILD
Victim is on a flat, firm surface ■■ If necessary, moves victim to ■■ Attempts CPR on a soft
a flat, firm surface surface
ADULT: ■■ Compresses the chest ■■ Compresses the chest less
Compresses chest at least 2 straight down at least 2 than 2 inches for 7 or more
inches deep for an adult inches for at least 24 of the times per 30 compressions
30 compressions
CHILD: ■■ Compresses the chest ■■ Compresses the chest less
Compresses chest about 2 straight down about 2 than 1¾ inches for 7 or more
inches deep for a child inches for at least 24 of the times per 30 compressions
30 compressions
Lets chest rise completely ■■ Compresses and fully ■■ Pauses while compressing
before pushing down again releases the chest without or releasing the chest for
pausing or taking hands 7 or more times per 30
off chest for 24 of the 30 compressions
compressions

SKILL ASSESSMENT TOOL: CPR—ADULT OR CHILD, CONTINUED
Compresses chest at a rate of ■■ Compresses center of the ■■ Compresses the chest less
at least 100 times per minute chest 24–36 times in about than 24 or more than 36
(30 compressions in about 18 18 seconds times in about 18 seconds
seconds)
Give ventilations ■■ Gives 2 ventilations that ■■ Gives 2 ventilations that do
make the chest clearly rise not make the chest clearly
and that last about 1 second rise and that last 2 or more
each seconds each
Return to compressions ■■ Gives ventilations and returns ■■ Gives ventilations and returns
to chest compressions within to compressions but takes 7
3–6 seconds or more seconds
SKILL ASSESSMENT TOOL: CPR—INFANT
Victim is on a flat, firm surface ■■ If necessary, moves victim to ■■ Attempts CPR on a soft
Compress chest about 1½ ■■ Compresses the chest ■■ Compresses the chest less
inches deep for an infant straight down at least 1½ than 1¼ inches for 7 or more
inches for at least 24 of the times per 30 compressions
30 compressions
Let chest rise completely before ■■ Compresses and releases ■■ Pauses while compressing
pushing down again the chest without pausing for or releasing the chest for
24 of the 30 compressions 7 or more times per 30
compressions
Compress chest at a rate of ■■ Compresses center of the ■■ Compresses the chest less
at least 100 times per minute chest 24–36 times in about than 24 or more than 36
(30 compressions in about 18 18 seconds times in about 18 seconds
seconds)
Give ventilations ■■ Gives 2 ventilations that ■■ Gives 2 ventilations that do
make the chest clearly rise not make the chest clearly
and that last about 1 second rise and that last 2 or more
each seconds each
Return to compressions ■■ Gives ventilations and returns ■■ Gives ventilations and returns
to chest compressions within to compressions but takes 7
3–6 seconds or more seconds

TWO-RESCUER CPR
SKILL CHART: TWO-RESCUER CPR—ADULT, CHILD AND INFANT
1. Rescuer 2 finds the correct hand position to give chest compressions.
■■ Adult: Place two hands on the center of the chest.
■■ Child: Place one or two hands on the center of the chest.
■■ Infant: Use the encircling thumbs technique.
cc Place thumbs next to each other on the center of the chest just below the nipple line.
cc Place both hands underneath the infant’s back and support the infant’s back with your
fingers.
cc Ensure that your hands do not compress or squeeze the side of the ribs.
2. Rescuer 2 gives chest compressions.
■■ Push hard, push fast.
cc Compress the chest at a depth of:
●● Adult: At least 2 inches but not more than 2.4 inches
●● Child: About 2 inches
●● Infant: About 1 ½ inches
cc Compress the chest at a rate of at least 100 per minute but no more than 120 per minute.
3. Rescuer 1 gives 2 ventilations.
4. Perform about 2 minutes of compressions and ventilations.
■■ Adult: Perform cycles of 30 compressions and 2 ventilations.
■■ Child and Infant: Perform cycles of 15 compressions and 2 ventilations.
5. Rescuers change positions at least every 2 minutes (5 cycles of 30 compressions and 2
ventilations) and/or while the AED is analyzing the heart rhythm.
■■ Rescuer 2 calls for a position change by using the word “change” at the beginning of the last
compression cycle and again at the end of the last compression cycle:
cc Adult: Use the word “change” in place of the word “30.”
cc Child: Use the word “change” in place of the word “15.”
■■ Rescuer 1 gives 2 ventilations.
■■ Rescuer 2 quickly moves to the victim’s head with their own mask.
■■ Rescuer 1 quickly moves into position at the victim’s chest and locates correct hand position on
the chest.
■■ Changing positions should take less than 5 seconds.
6. Rescuer 1 begins chest compressions.
■■ Continue cycles of compressions and ventilations.
Continue CPR until:
■■ Another trained responder or responders take over, such as a member of your safety team or EMS
personnel, and relieve you from giving compressions or ventilations.

SKILL ASSESSMENT TOOL: TWO-RESCUER CPR—ADULT, CHILD AND INFANT
Change positions ■■ Changes positions in 5 ■■ Changes positions but takes
seconds more than 5 seconds
Compress the chest and give ■■ ADULT: ■■ ADULT:
ventilations at the appropriate Cycles consist of 30 Cycles consist of less or
rate compressions and 2 more than 30 compressions
ventilations and 2 ventilations
■■ CHILD AND INFANT: ■■ CHILD AND INFANT:

Cycles consist of 15 Cycles consist of less or
compressions and 2 more than 15 compressions
ventilations and 2 ventilations
AED
SKILL CHART: USING AN AED
1. Turn on the AED and follow the voice and/or visual prompts.
2. Wipe the victim’s bare chest dry.
Tip: Remove any medication patches with a gloved hand.
3. Attach the AED pads to the victim’s bare, dry chest.
■■ Place one pad on the victim’s upper right chest and the other pad on the left side of the chest.
cc For a child or an infant: Use pediatric AED pads, if available. If the pads risk touching each
other, place one pad in the middle of the child’s chest and the other pad on the child’s back,
between the shoulder blades.
4. Plug in the connector, if necessary.
5. Stand clear.
6. Analyze the heart rhythm.
■■ Push the Analyze button, if necessary. Let the AED analyze the heart rhythm.
7. Deliver a shock or perform CPR based on the AED recommendation.
■■ If a shock is advised:
cc Make sure no one, including you, is touching the victim.
cc Say, “Everyone, stand clear!”
cc Deliver the shock by pushing the “Shock” button, if necessary.
cc After delivering the shock, perform about 2 minutes of CPR.
cc Continue to follow the prompts of the AED.
■■ If no shock is advised:
cc Perform about 2 minutes of CPR.
cc Continue to follow the prompts of the AED.

SKILL ASSESSMENT TOOL: USING AN AED
Attach AED pads to bare chest ■■ Places one pad on the upper ■■ Places one pad on the upper
right chest and one on the left chest
left side of the chest ■■ Places one pad on the lower
right side of the chest
Make sure that pads do not ■■ Places pads on the chest so ■■ Places pads on the chest,
touch (child or infant) that they are separated from but pads touch each other
each other ■■ Places the center of one pad
■■ Places one pad in the middle more than 2 inches from the
of the chest and one on the center of the chest
back centered between the ■■ Places the center of one
shoulder blades pad more than 2 inches from
■■ Places pads so that the heart the center of both shoulder
is between the two pads blades
Make sure that no one is ■■ Says, “Everyone, stand ■■ Does not say, “Everyone,
touching the victim clear!” before pushing the stand clear!”
“Analyze” button, if necessary ■■ Pushes the “Analyze” button
■■ Says, “Everyone, stand if necessary, before saying,
clear!” before pushing the “Everyone, stand clear!”
“Shock” button, if necessary ■■ Pushes the “Shock” button,
if necessary, before saying,
“Everyone, stand clear!”
After delivering the shock, or if ■■ Returns to chest ■■ Returns to chest
no shock is advised, perform compressions within 5 compressions after 6 or more
about 2 minutes of CPR seconds seconds
CPR WITH AIRWAY OBSTRUCTION

SKILL CHART: CPR WITH AIRWAY OBSTRUCTION
Note: If a person who is choking becomes unresponsive, summon EMS if you have not already
done so then lower them to a firm, flat surface and immediately begin CPR, starting with chest
compressions.
1. Give 30 chest compressions.
2. Before attempting ventilations, open the victim’s mouth and look for the object.
■■ If you see an object in the victim’s mouth, carefully remove it using your finger.
■■ Never perform a blind finger sweep.
3. Give 2 ventilations.
Continue to provide care by repeating this cycle until:

■■ The victim begins to breathe on their own.
■■ Another trained rescuer takes over.
■■ More advanced medical personnel, such as EMS personnel, take over.
■■ You are too exhausted to continue.
Note: Continuing cycles of 30 compressions and 2 ventilations is the most effective way to provide
care. Even if ventilations fail to make the chest rise, compressions may help clear the airway by
moving the blockage to the upper airway where it can be seen and removed.

SKILL ASSESSMENT TOOL: CPR WITH AIRWAY OBSTRUCTION
Victim is on flat, firm surface ■■ If necessary, moves victim to ■■ Attempts CPR on a soft
ADULT: ■■ Exposes the chest ■■ Does not expose the chest
Compress chest at least 2 ■■ Compresses the chest ■■ Compresses the chest less
inches deep for an adult straight down, at least 2 than 2 inches
inches ■■ Does not allow the chest
■■ Allows the chest to fully recoil to fully recoil between
between compressions (26 compressions
of 30 compressions)
CHILD: ■■ Compresses the chest ■■ Compresses the chest less
Compress chest about 2 inches straight down about 2 inches than or more than 2 inches
deep for a child ■■ Exposes the chest ■■ Does not expose the chest
■■ Allows the chest to fully recoil ■■ Does not allow the chest
between compressions (26 to fully recoil between
of 30 compressions) compressions
INFANT: ■■ Exposes the chest ■■ Does not expose the chest

Compress chest about 1 ½ ■■ Compresses the chest ■■ Compresses the chest less
inches deep for an infant straight down, about 1 ½ than 1 ½ inches
inches
Opens the victim’s mouth to ■■ Opens the victim’s mouth ■■ Does not open the victim’s
look for a visible object ■■ If an object is visible, mouth
performs a finger sweep to ■■ Performs a blind finger
remove the object sweep
Gives ventilations ■■ Opens the airway and gives 2 ■■ Does not open the airway or
ventilations that last about 1 give ventilations
second each ■■ Gives ventilations that last 2
or more seconds each
Return to compressions ■■ Minimize interruptions to less ■■ Gives ventilations and returns
than 5 seconds to compressions but takes 5
or more seconds

LESSON 7
FIRST AID

■■ Guide the discussion on Secondary Assessment.
■■ Discuss all points in the topic Responding to Injuries.
■■ Complete the skill practice session for Controlling Bleeding.
■■ Complete the activity Common Injuries.
■■ Complete the activity First Aid Scenarios.
■■ Complete the activity When Things Do Not Go as Practiced.
■■ Complete the activity Rescue Skills Review.
cc Surveillance Activity 2
cc Secondary Assessment
cc Responding to Sudden Illnesses
cc Responding to Injuries
cc Head, Neck and Spinal Injuries on Land
LESSON OBJECTIVES
■■ Demonstrate how to perform a secondary assessment.
■■ Identify how to recognize and care for a victim of sudden illness, injuries and shock.
■■ Demonstrate how to control external bleeding.
■■ Demonstrate the ability to work as a team to implement an EAP, perform a secondary
assessment and provide first aid care.
■■ Demonstrate how to perform front and rear head-hold escapes.
■■ Demonstrate how to give in-water ventilations.

■■ Nitrile latex-free disposable gloves (one pair per participant)
■■ Chair
■■ Dressing and bandages (one per every two participants)

LESSON PREPARATION
review questions, the eLearning module they completed and the videos they watched.
INSTRUCTOR NOTES
completion certificates they received when they completed eLearning Module 7: First Aid.
■■ When practicing in-water ventilations, remind participants not to give actual ventilations but
rather to simulate ventilations on their partner.
■■ Participants are not required to participate in each role during the multiple-rescuer response
scenario.
TEACHING TIPS
practice.

TOPIC: S ECONDARY ASSESSMENT Time: 5 minutes
SECONDARY ASSESSMENT
LECTURE ■■ After you have completed a primary assessment and determined
AND GUIDED that there are no life-threatening conditions, perform a secondary
DISCUSSION: assessment to determine if there are any additional non-life-
threatening conditions that would require you to provide care.
■■ Ask participants: What information should you check for when using
SAMPLE to take a brief history related to the injury or illness?
Course cc S = Signs and symptoms
Presentation: cc A = Allergies
Slides 106–109
cc M = Medications
Participant’s
cc P = Pertinent past medical history
Manual:
Chapter 10 cc L = Last oral intake
cc E = Events leading up to the incident
■■ Ask participants: What should be included when performing a secondary

assessment?
cc Visually inspect the person’s body, looking carefully for any bleeding, cuts,
bruises and obvious deformities.
cc Look for a medical identification (ID) tag, necklace or bracelet on the
person’s wrist, neck or ankle.
cc Check the person’s ability to move body parts. Caution the person to not
move any parts if they experience discomfort or pain. If the person is unable
to move a body part or is experiencing dizziness or pain on movement:
●● Help the person rest in a comfortable position.
●● Keep the person from getting chilled or overheated.
●● Reassure the person.
●● Determine whether to summon emergency

medical services (EMS) personnel.
●● Continue to watch for changes in the level of
consciousness (LOC) and breathing.

TOPIC: R ESPONDING TO INJURIES Time: 25 minutes
CONTROLLING BLEEDING
GUIDED ■■ Ask participants: What are the four main types of open wounds?
DISCUSSION: Answers:
cc Abrasion
cc Laceration
cc Avulsion
REFERENCES: cc Puncture
Course
Presentation:
Slide 111
Participant’s
Manual:
Chapter 10
SKILL ■■ Ask participants: What questions do you have about the “Responding to
PRACTICE: Sudden Illnesses” video?
■■ Ask participants: What questions do you have about the “Responding to
Injuries” video?
■■ Pair up participants. One participant will be the lifeguard and the other will be
the victim; they will switch roles for the second scenario.
REFERENCES:
■■ Provide each participant with a pair of nitrile, latex-free disposable gloves.
Course
Presentation: ■■ Provide a bandage and dressing for each pair of the participants.
Slide 112 ■■ Guide participants through the steps listed on the Controlling External Bleeding
Participant’s skill sheet in Chapter 10, First Aid, in the Lifeguarding Manual.
Manual: ■■ Have participants switch roles and repeat the skill practice.
Chapter 10
■■ Clearly observe each participant’s performance and provide corrective
feedback.
SHOCK
GUIDED ■■ Ask participants: What are some signs and symptoms of shock?
DISUCSSION: Answers: Responses should include the following:
cc Restlessness or irritability
cc Altered LOC
cc Pale or ashen, cool, moist skin
REFERENCES: cc Nausea or vomiting
Course cc Rapid breathing and pulse
Presentation: cc Excessive thirst
Slides 113–115
■■ Ask participants: What are some ways to minimize the effects of shock?
Participant’s Answers: Responses may include the following:
Manual:
cc Make sure that EMS personnel have been summoned.
Chapter 10
cc Monitor the victim’s condition and watch for changes in LOC.
cc Control any external bleeding.
cc Keep the victim from getting chilled or overheated.
cc Have the victim lie flat on their back.
cc Cover the victim with a blanket to prevent loss of body heat. Do not overheat
the victim—your goal is to maintain a normal body temperature.
cc Comfort and reassure the victim until EMS personnel take over.
cc Administer emergency oxygen, if available and trained to do so.
cc Do not give food or drink to a victim of shock, even if the victim asks for
them.

COMMON INJURIES
ACTIVITY: ■■ Explain that Chapter 10, First Aid, of the Lifeguarding Manual is a resource for
first aid care for many specific types of injuries.
■■ Divide the participants into small groups. Assign each group one of the
following types of injury:
cc Nosebleeds
REFERENCES:
cc Mouth and teeth injuries (no head, neck or spinal injury suspected)
Participant’s
Manual: cc Knocked-out tooth
Chapter 10 cc Animal or human bites
cc Insect stings
cc Burns
■■ Ask participants to research and report their findings to the class as to what
care should be provided for their assigned type of injury.
■■ Allow up to 3 to 5 minutes for the group work. Circulate among groups to
monitor progress and provide assistance when necessary.
■■ Re-assemble the class and call on group leaders to share the group’s findings.
INJURY OR CARE STEPS
ILLNESS
Nosebleeds ■■ Have the victim sit leaning slightly forward to prevent swallowing or choking on
the blood.
■■ Pinch the nostrils together for about 5 to 10 minutes or until the bleeding stops.
■■ After the bleeding stops, have the victim avoid rubbing, blowing or picking
the nose.
■■ Medical attention is needed if the bleeding persists or recurs or if the victim
says the nosebleed was a result of high blood pressure.
■■ If the victim becomes unresponsive, perform a primary assessment. If the victim
is breathing, place the victim on their side to allow blood to drain from the nose.
Summon EMS personnel immediately.
Mouth and ■■ Rinse the victim’s mouth with cold tap water, if available.
Teeth Injuries ■■ Have the victim lean slightly forward or place the victim on their side to prevent
(No Head, the victim from swallowing the blood, which could cause nausea
Neck or or vomiting.
Spinal Injury ■■ Apply a dressing.
Suspected)
Knocked-Out ■■ Control any bleeding.
Tooth ■■ Have the victim bite down on a rolled sterile dressing in the space left by the
tooth (or teeth).
■■ Save any displaced teeth.
cc Carefully pick up the tooth by the crown (white part), not the root.
cc Do not scrub or attempt to clean the tooth or remove any tissue fragments.
cc Place the tooth in a Hank’s Balanced Salt solution. If not available, place the
tooth in egg white, coconut water or whole milk. If none of these solutions
are available, place the tooth in the victim’s saliva (not in the mouth).
■■ Advise the victim to get to an emergency department or dentist with the tooth
as soon as possible. For the greatest chance to save the tooth, it needs to be
re-implanted within 30-60 minutes.

Animal or ■■ Summon EMS personnel if the wound bleeds severely or if the animal is
Human Bites suspected to have rabies.
■■ For severe bleeding, control the bleeding first. Do not clean the wound. It will be
properly cleaned at the hospital.
■■ If the bleeding is minimal:
cc Wash the wound with soap and water, then rinse with clean water.
cc Apply a small amount of antibiotic wound ointment, cream or gel to the
wound if the person has no known allergies or sensitivities to the ingredients.
cc Control the bleeding.
cc Cover with a sterile bandage.
Burns ■■ Stop the burning by removing the person from the source of the burn.
■■ Cool the burned area with large amounts of cool or cold tap water for at least
10 minutes. If cool or cold water is not available, use a clean cool or cold
compress.
■■ Monitor the victim for hypothermia when cooling large burns.
■■ Cover the burned area loosely with a sterile dressing.
■■ Comfort and reassure the victim.
Insect Stings ■■ Examine the sting site to see if the stinger is in the skin. If a stinger is present,
scrape it away with the edge of a plastic card, such as a credit card.
■■ Wash the wound with soap and water.
■■ Cover the site with a dressing to help keep the wound clean.
■■ Apply a cold pack to the site to reduce pain and swelling.
■■ Watch the victim for signs of a severe allergic reaction and care for life-
threatening conditions.
■■ Monitor the victim’s condition (look for changes in LOC) and keep the victim
comfortable.

TOPIC: P
UTTING IT ALL TOGETHER—FIRST Time: 20 minutes
AID SCENARIOS
FIRST AID SCENARIOS
ACTIVITY: ■■ Tell participants that they will now participate in two first aid scenarios that will
require them to perform a secondary assessment.
■■ Explain that they will work in groups of three for each scenario. Some of the
scenarios require one lifeguard, a child victim and a parent, whereas others
assume that two lifeguards are providing care to one victim.
REFERENCES: ■■ Assign the scenarios randomly, such as through a drawing. A total of six
Course scenarios are provided. It is acceptable for more than one group to complete
Presentation:
Slides 117–136 the same scenario.
Participant’s
■■ Allow a few minutes for those playing the role of victim to review the signs and
Manual: symptoms of the condition assigned using the Lifeguarding Manual.
Chapter 10 ■■ Explain that lifeguards should perform a secondary assessment and provide
care for the conditions found.
■■ Be sure to have the appropriate equipment and supplies available for use in the
scenarios, including personal protective equipment (PPE) and first aid supplies.
■■ After they have completed two scenarios, re-assemble the group and discuss
the activity. Each group should:
cc Explain the scenario.
cc Describe initial steps taken, such as calling for backup coverage if necessary.
cc Describe the injury or illness, including signs and symptoms.
cc Explain the care steps provided, including summoning EMS personnel if
appropriate.
cc Explain any follow-up instructions given to the victim.

Scenario 1: You are on duty lifeguarding at an outdoor pool. A child comes to you saying
that they were just in the concession area eating a snack when they were stung by a bee.
The child’s parent is swimming laps in the adult lap swim lane.
Initial Steps ■■ Signal to obtain backup coverage for your zone.
■■ Get the attention of the child’s parent and obtain consent.
■■ Ask if the child has a known allergy to bee stings.
Signs and ■■ Pain
Symptoms ■■ Redness or swelling
■■ Possible presence of a stinger
■■ Signals of an allergic reaction:
cc Rash or hives
cc Feeling of tightness in the chest and throat
cc Shortness of breath
cc Swelling of the face, neck or tongue
Care Steps ■■ Examine the sting site to see if the stinger is in the skin. If it is still present,
remove the stinger by scraping it away with the edge of a plastic card, such
as a credit card.
■■ Wash the wound with soap and water.
■■ Cover the site with a dressing and keep the wound clean.
■■ Apply a cold pack to the site to reduce pain and swelling.
■■ Watch the victim for signals of an allergic reaction.
■■ Monitor the victim’s condition and look for changes in LOC.
■■ Keep the victim comfortable.
■■ Summon EMS personnel for any life-threatening conditions, such as a
breathing emergency.
Follow-Up ■■ Have the child remain in the first aid area for a few minutes and watch the
child for signs of an allergic reaction.
■■ Tell the child and parent to alert a lifeguard or other safety team member if
symptoms get worse.

Scenario 2: You are on break when an adult tells you that a friend is not feeling well and
needs help. The patron tells you that they are wearing a diabetic ID bracelet.
Initial Steps ■■ Obtain consent from the patron who is not feeling well.
Signs and ■■ The patron told you they are not feeling well and their medical ID bracelet
Symptoms tells you of the condition.
Care Steps ■■ If the person is awake and can safely swallow and follow simple commands,
give them sugar.
■■ If it is available, give 15 to 20 grams of sugar in the form of glucose tablets
to the victim. If not available, 15 to 20 grams of sugar from several sources
can be given, including glucose- and sucrose-containing candies, jelly
beans, orange juice or whole milk.
■■ Summon EMS personnel if:
cc The person is or becomes unresponsive.
cc The person is responsive but not fully awake and is unable to swallow.
cc The person does not feel better within about 10 to 15 minutes after
taking sugar, or gets worse.
cc A form of sugar cannot be found immediately. Do not spend time looking
for it.
Follow-Up ■■ Ask the patron to remain there until they clearly feel better, at least 5 minutes.
■■ Tell the person to alert a lifeguard or staff member if symptoms recur.

Scenario 3: You are on a break in the lifeguard room. Through the window, you notice a
patron on the deck who appears to be having a seizure.
Initial Steps ■■ Activate the EAP.
Signs and ■■ May last 1 to 3 minutes and can produce a wide range of signs and
Symptoms symptoms.
■■ May lose consciousness and fall.
■■ May become rigid and then experience sudden, uncontrollable muscular
convulsions lasting several minutes.
■■ Breathing may become irregular and even stop temporarily.
Care Steps ■■ Protect the person from injury by moving nearby objects away from the
person.
■■ Position the person on their side, if possible, after the seizure passes so that
fluids (saliva, blood, vomit) can drain from the mouth.
■■ Check to see if the person was injured during the seizure.
■■ Summon EMS personnel if:
cc The seizure occurs in the water.
cc This is the person’s first seizure.
cc The seizure lasts more than 5 minutes.
cc The person has repeated seizures with no lucid period.
cc The person appears to be injured.
cc The cause of the seizure is unknown.
cc The person is pregnant.
cc The person is known to have diabetes.
cc The person fails to regain consciousness after the seizure.
cc The person is elderly and may have suffered a stroke.
Follow-Up ■■ Stay with the person until they are fully conscious and aware of their surroundings.
■■ Offer to let the person remain in a first aid area to rest.

Scenario 4: You are hosing down a section of the deck as part of your secondary
responsibilities. A regular patron approaches and tries to ask you a question. Their
speech seems impaired and you cannot understand what they are saying.
■■ Obtain consent if able to do so.
Signs and ■■ Sudden change in how the body is working or feeling, such as sudden
Symptoms weakness or numbness of the face, an arm or a leg; often only on one side
of the body
■■ Difficulty with speech (trouble speaking and being understood and difficulty
understanding others)
■■ Blurred or dimmed vision
■■ Sudden, severe headache, dizziness or confusion
■■ Loss of balance or coordination
■■ Trouble walking
■■ Ringing in the ears
Care Steps ■■ Summon EMS personnel immediately.
■■ Think FAST:
cc Face—Ask the person to smile. This will show if there is drooping or
weakness in the muscles on one side of the face. Does one side of the
face droop?
cc Arm—Ask the person to raise both arms to find out if there is weakness in
the limbs. Does one arm drift downward?
cc Speech—Ask the person to speak a simple sentence to listen for slurred
or distorted speech. Example: “The sky is blue.” Can the victim repeat the
sentence correctly?
cc Time—Note the time that the signs and symptoms began and summon
EMS personnel immediately.
Follow-Up ■■ Comfort and reassure the person until EMS personnel arrive.
■■ Collect any of the person’s belongings and give to EMS.

Scenario 5: You are on duty as a lifeguard. Your guard station is on the deck at the
shallow end of the pool. An adult is exiting the pool using the ladder, then slips and
hits their mouth on the railing. When you approach the victim, you notice that they are
missing a tooth, which the victim is holding in their hand, and bleeding from the mouth.

Signs and ■■ Tooth is missing and the patron has it in their possession.
Symptoms ■■ The patron is bleeding from the mouth.
Care Steps ■■ Rinse the victim’s mouth with cold tap water, if available.
■■ Have the victim lean slightly forward, or place the victim on their side.
■■ Try to prevent the victim from swallowing the blood, which could cause
nausea or vomiting.
■■ Have the victim bite down on a rolled sterile dressing in the space left by the
tooth.
■■ Save the displaced tooth.
■■ Carefully pick up the tooth by the crown (white part), not the root.
■■ Place the tooth in a Hank’s Balanced Salt Solution. If not available, place
the tooth (in order of preference) in egg white, coconut water or whole milk.
If none of these solutions are available, place the tooth in the victim’s saliva
(not in the mouth).
Follow-Up ■■ Advise the victim to get to a dentist with the tooth as soon as possible.
Scenario 6: You are on break when a concession worker comes to you and tells you help
is needed. Another concession worker has been burned by hot oil from the
popcorn machine.
Initial Steps ■■ Obtain consent.
Signs and ■■ Burned area on an arm and hand—red skin with blisters beginning to form
Symptoms
Care Steps ■■ Stop the burning by removing the person from the source of the burn.
■■ Cool the burned area with large amounts of cool or cold tap water for at
least 10 minutes. If cool or cold water is not available, use a cool or cold
compress that is clean. Monitor the victim for hypothermia when cooling
large burns.
■■ Cover the burned area loosely with a sterile dressing.
■■ Comfort and reassure the victim.
Follow-Up ■■ Advise the person to follow up with a doctor.

TOPIC: W
HEN THINGS DO NOT GO AS Time: 30 minutes
PRACTICED
WHEN THINGS DO NOT GO AS PRACTICED

VIDEO: ■■ Explain to participants that the video segment will provide important information
regarding the techniques to use when things do not go as practiced. The skills
in this video will be practiced later in the water. They include:
cc Front and Rear Head-Hold Escapes
cc In-Water Ventilations
REFERENCES:
Course
■■ Refer participants to the skill sheets in Chapter 6, Rescue Skills, in the
Presentation: Lifeguarding Manual.
Slide 137 ■■ Show the video segment “When Things Do Not Go as Practiced.”
Participant’s ■■ Answer participants’ questions about the video segment.
Manual:
Chapter 6
IN WATER SKILL SESSION—WHEN THINGS DO NOT GO AS PRACTICED

SKILL ■■ Explain to participants that during the skill session you will demonstrate skills
PRACTICE: and guide them through practice.
■■ Pair up participants and explain that they will take turns as a victim and a
rescuer for each skill.
■■ For each skill, organize them so that they can clearly see and hear. Be sure to
provide any instructions related to their position or how they should behave as
REFERENCES: victims.
Participant’s
Manual: ■■ Lead them through a land demonstration and practice for the following skills:
Chapter 6 cc Front Head-Hold Escape
●● Lifeguards: deep water, facing victim
●● Victims: deep water
cc Rear Head-Hold Escape

●● Lifeguards: deep water, back to victim
●● Victims: deep water
cc In-Water Ventilations—Shallow Water (simulate ventilations)

●● Lifeguards: standing in shallow water
●● Victims: passive
cc In-Water Ventilations—Deep Water (simulate ventilations)
●● Lifeguards: treading in deep water
●● Victims: passive

■■ For the Shallow Water Lifeguarding course, participants will practice the front
and rear head-hold escapes in shallow water.
■■ Omit the in-water ventilations—deep water when teaching the Shallow Water
Lifeguarding course.
■■ Participants should practice the skills until they are able to meet performance
criteria.
■■ Observe each participant’s performance of the skill and provide corrective
feedback.

TOPIC: I N-WATER SKILL SESSION—RESCUE Time: 45 minutes
SKILLS REVIEW
IN-WATER SKILL SESSION—RESCUE SKILLS REVIEW
SKILL ■■ Designate three stations for review skills and divide participants into three groups.
PRACTICE: ■■ Count off participants as “ones” and “twos” so that you can easily assign roles at
each station and for each skill practice.
■■ Participants will practice the rescues as many times as possible in about a
5-minute period.
REFERENCES: ■■ Rotate groups every 5 to 7 minutes.
Participant’s ■■ Observe participants and provide feedback as they practice the following skills:
Manual: cc Shallow Water
Chapter 6
●● Submerged Passive Victim
cc Deep Water
●● Passive Victim on the Surface—Front Approach
●● Passive Victim on the Surface—Rear Approach
cc Deep Water
●● Extrication Using a Backboard at the Pool Edge
cc Multiple-Rescuer Response Scenarios (Appendix B):

●● Scenario 5
●● Scenario 6
Instructor’s Note: Participants will not be required to participate

in each role during the multiple-rescuer response scenario final
skills evaluation.

■■ For the Shallow Water Lifeguarding course, participants will practice the front
and rear head-hold escapes in shallow water.
■■ Participants will practice the rescues as many times as possible in about a
5-minute period.
■■ Rotate groups every 5 to 7 minutes.
■■ Stations:
cc Passive Victim
●● Passive Victim on the Surface—Rear Approach
●● Passive Victim on the Surface—Front Approach
●● Extrication Using a Backboard at the Pool Edge
cc Distressed Swimmer
●● Simple Assist for a Distressed Swimmer
●● Reaching Assist from the Deck for a Distressed Swimmer
cc Multiple-Rescuer Response Scenarios (Appendix B)

●● Scenario 5
●● Scenario 6

ASSIGNMENT
cc Complete eLearning Module 8: Head, Neck and Spinal Injuries.
cc Read Chapter 10: Caring for Head, Neck and Spinal Injurues in the
Lifeguarding Manual.
REFERENCES:
Course
■■ Remind participants to prepare for the CPR/AED for Professional Rescuers and
Presentation: First Aid online exam by reviewing chapters 7 through 10 in the Lifeguarding
Slide 138 Manual. The online exam is part of the eLearning conclusion module and must
be completed prior to attending the last in-person session.
cc Participants will have two attempts to complete the exam before the
conclusion module locks.
cc If participants are unsuccessful at both attempts, the conclusion module will
lock and participants will be prevented from accessing the final exam for 24
hours. Participants should use this time to review the Lifeguarding Manual
and eLearning Modules 7 through 10 prior to reattempting the CPR/AED for
Professional Rescuers and First Aid Final Exam.

SECONDARY ASSESSMENT
SKILL CHART: USING SAMPLE TO TAKE A BRIEF MEDICAL HISTORY
Take a brief history using SAMPLE:
1. Signs and symptoms:
■■ What happened?
■■ Where do you feel any pain or discomfort?
■■ Do you have any numbness or loss of sensation? If so, where?
2. Allergies:
■■ Do you have any allergies, such as to medications or food? If so, what type of reactions have
you experienced when you were exposed?
3. Medications:
■■ Do you have any medical conditions or are you taking any medications? If so, what conditions
do you have or what medications are you taking?
■■ Have you taken any medications in the past 12 hours?
4. Pertinent past medical history:
■■ Have you recently been ill?
■■ Do you have any medical conditions?
■■ Have you experienced any recent falls, accidents or blows to the head?
■■ Have you had surgery, been in a traumatic accident or had a medical emergency?
5. Last oral intake:
■■ When did you last eat or drink?
■■ What did you last eat or drink?
6. Events leading up to the incident:
■■ What were you doing before the incident occurred?
■■ What were you doing when the incident occurred?

SKILL CHART: CHECKING A RESPONSIVE PERSON
1. Check the head.
■■ Look at the scalp, face, ears, eyes, nose and mouth for cuts, bumps, bruises and depressions.
■■ Note if the victim has any changes in the level of consciousness, such as dizziness, or feels
light-headed.
2. Check skin appearance and temperature.
■■ Feel the victim’s forehead with the back of your hand and note if the skin is cold or hot.
■■ Look at the coloring of the victim’s face and lips.
■■ Look at the victim’s skin and note if the skin is moist or dry or if it is red, pale, flushed or ashen.
3. Check the neck.
■■ Ask the victim to move their head from side to side, if there is no discomfort and if an injury to
the neck is not suspected.
■■ Note pain, discomfort or inability to move.
4. Check the shoulders.
■■ Ask the victim to shrug their shoulders.
5. Check the chest and abdomen.
■■ Ask the victim to take a deep breath and blow air out.
■■ Listen for difficulty or changes in breathing.
■■ Ask the victim if they are experiencing pain during breathing.
6. Check the arms.
■■ Check one arm at a time.
■■ Ask the victim to move their hand and fingers and to bend the arm.
7. Check the legs.
■■ Check one leg at a time.
■■ Ask the victim to move their foot and toes and to bend the leg.
8. Provide care for any conditions found.
9. Have the victim rest in a comfortable position if they can move all body parts without pain or
discomfort and have no other apparent signs or symptoms of injury or illness. Continue to watch for
changes in consciousness and breathing.
SKILL ASSESSMENT TOOL: USING SAMPLE TO TAKE A BRIEF MEDICAL HISTORY
Asks questions to determine a ■■ Gathers information about ■■ Does not ask any questions
brief history what happened, possible ■■ Does not ask questions
signs and symptoms or brief about what happened,
medical history possible signs and symptoms
or brief medical history
Checking a Conscious Person
Checks for signs and symptoms ■■ Visual inspection from head ■■ Does not perform an
of injuries or sudden illnesses to toe looking carefully for assessment
any bleeding, cuts, bruises ■■ Does not recognize obvious
and obvious deformities signs or symptoms
Checks for medical conditions ■■ Visual inspection looking for ■■ Does not look for medical ID
that may need to be considered a medical ID tag, necklace or tag, necklace or bracelet
bracelet
Monitors the person’s condition ■■ Watches for changes in ■■ Does not look at victim
consciousness or breathing

CONTROLLING EXTERNAL BLEEDING
SKILL CHART: CONTROLLING EXTERNAL BLEEDING
1. Control any bleeding.
2. Place a sterile dressing over the wound.
3. Apply direct pressure until bleeding stops.
4. Clean the wound thoroughly with soap (if available) and water. If possible, irrigate an abrasion with
clean, warm, running tap water for about 5 minutes to remove any dirt and debris.
5. If bleeding continues, use a new sterile dressing and apply more pressure.
6. After bleeding stops, remove the dressing and apply wound gel or an antibiotic ointment to the
wound, if one is available, the victim has no known allergies or sensitivities to the medication and
local protocols allow you to do so.
7. Cover the wound with a sterile dressing and bandage (or with an adhesive bandage).
8. Wash your hands immediately after providing care.
SKILL ASSESSMENT TOOL: CONTROLLING EXTERNAL BLEEDING

Uses personal protective ■■ Puts on disposable gloves ■■ Does not put on disposable
equipment before covering wound gloves
■■ Puts on disposable gloves
after covering wound
Covers the wound with a ■■ Places dressing over wound ■■ Places dressing away from
(sterile) dressing and applies ■■ Applies pressure to wound wound area
direct pressure until bleeding ■■ Secures dressing in place ■■ Does not apply pressure
stops with roller gauze ■■ Uses pressure points instead
of direct pressure
■■ Roller gauze does not stay in
place
Applies additional dressings ■■ Visual inspection looking for ■■ Does not look for medical ID
and more direct pressure (if a medical ID tag, necklace or tag, necklace or bracelet
bleeding does not stop) bracelet
Monitors the person’s condition ■■ Adds additional dressings to ■■ Removes initial dressing
initial dressing ■■ Does not add additional
■■ Applies pressure to wound dressings
■■ Does not apply pressure

WHEN THINGS DO NOT GO AS PRACTICED
SKILL CHART: FRONT HEAD-HOLD ESCAPE
1. As soon as the victim grabs hold, take a quick breath, tuck your chin down, turn your head to either
side, raise your shoulders and submerge with the victim.
2. Once under water, grasp the victim’s elbows or the undersides of the victim’s arms just above the
elbows.
3. Forcefully push up and away. Keep your chin tucked, your arms fully extended and your shoulders
raised until you are free.
4. Quickly swim under water, out of the victim’s reach. Surface and reposition the rescue tube and try
the rescue again.
SKILL CHART: REAR HEAD-HOLD ESCAPE
1. Take a quick breath, tuck your chin down, turn your head to either side, raise your shoulders and
submerge with the victim.
2. Once under water, grasp the victim’s elbows or the undersides of the victim’s arms just above the
elbows.
3. Forcefully push up and away while twisting your head and shoulders. Keep your chin tucked, your
arms fully extended and your shoulders raised until you are free.
4. Quickly swim under water out of the victim’s reach. Surface and reposition the rescue tube and try
the rescue again.
SKILL ASSESSMENT TOOL: ESCAPES
Releases the victim’s hold ■■ Presses victim’s arms up and ■■ Does not release the victim’s
pushes victim away hold
Swims away to safety ■■ Swims under water to a safe ■■ Victim grabs rescuer again
distance from the victim
Re-attempts the rescue ■■ Repositions the rescue tube ■■ Does not re-attempt a rescue
and attempts to rescue the
victim again

IN-WATER VENTILATIONS
SKILL CHART: IN-WATER VENTILATIONS
1. Ensure that the rescue tube is placed under the victim so the victim’s head naturally falls back to an
open-airway position.
2. From behind the victim’s head, position the resuscitation mask, seal the mask and open the airway.
3. Give ventilations.
4. Remove the victim from the water as soon as conditions allow, then immediately resume providing
care.
Instructor’s Note: Remind participants not to give ventilations but rather to

simulate ventilations on their partner.

Opens the airway ■■ Performs a jaw-thrust ■■ Does not open the airway by
maneuver using a jaw-thrust maneuver
Seals mask and gives simulated ■■ Properly seals mask and ■■ Mask is not properly sealed
ventilations simulates ventilations ■■ Simulated ventilations are not
given

LESSON 8
HEAD, NECK AND SPINAL INJURIES
IN THE WATER

Shallow Water Lifeguarding Lesson Length: 2 hours, 15 minutes

■■ Discuss all points in the topic Caring for Head, Neck and Spinal Injuries in the Water.
■■ Complete the skill practice Spinal Injuries— Shallow Water.
■■ Complete the skill practice Spinal Injuries— Deep Water.
LESSON OBJECTIVES
■■ Demonstrate how to care for victims with head, neck and spinal injuries in shallow and
deep water.
■■ Demonstrate how to care for victims with head, neck and spinal injuries in shallow water only
(Shallow Water Lifeguarding and Aquatic Attraction Lifeguarding).

■■ Backboards, each equipped with one strap and head immobilizer (one for every three
participants)
LESSON PREPARATION
■■ To save time, have all equipment and supplies prepared and available on the pool deck.
INSTRUCTOR NOTES
completion certificates they received when they completed eLearning Module 8: Head, Neck
and Spinal Injuries.
■■ A facility with a low edge is preferred when practicing the spinal backboarding procedure, but
if the facility has a large gap between the pool edge and the surface of the water, an additional
participant may be used to stabilize the backboard by holding the backboard (on the opposite
side of the rescuing lifeguard). This allows participants to simulate the technique for practice.
Remind participants that this is not a different backboarding technique and that the additional
participant is not in the role of an assisting rescuer and should not help to secure or extricate
the victim.
■■ When practicing deep water spinal backboarding procedure, participants only need to practice
as the rescuing lifeguard. There is no need to have participants rotate to different positions.

TEACHING TIPS
practice.
■■ Set up groups so that you can observe each group, but allow enough room for the groups to conduct
the skills and scenarios without disrupting each other or causing injury.

TOPIC: C
ARING FOR HEAD, NECK AND Time: 5 minutes
SPINAL INJURIES IN THE WATER
CARING FOR HEAD, NECK AND SPINAL INJURIES IN THE WATER
GUIDED
DISCUSSION: Science Note: Reassessment of protocols has shown that
packaging a victim can be detrimental. They often will lie on spine
boards for hours in the emergency room which causes anxiety and
can cause physical damage. Research indicates that the damage
has likely already occurred with the initial injury. The focus for
REFERENCES: lifeguards should be on safely extricating the person from the
Course water while maintaining stabilization. Studies have shown that the
Presentation: application of cervical collars can cause further injury.
Slides 141–144
Participant’s ■■ You should suspect a possible head, neck or spinal injury only if the
Manual: activity was high-impact or high-risk and the signs or symptoms of
Chapter 11
injury are present.
■■ Ask participants: What are some examples of high-impact/high-risk
activities in aquatic environments?
Answers: Responses should include:
cc Entering head-first into shallow water.
cc Falling from greater than a standing height.
cc Entering the water from a height, such as a diving board, water slide,
embankment, cliff or tower.
cc Striking a submerged or floating object.
cc Receiving a blow to the head.
cc Colliding with another swimmer.
cc Striking the water with high impact, such as falling while water skiing or
surfing.
■■ Ask participants: What signs and symptoms might indicate a possible
head, neck or spinal injury?
Answers: Responses should include:
cc Unusual bumps, bruises or depressions on the head, neck or back
cc Heavy external bleeding of the head, neck or back
cc Bruising of the head, especially around the eyes and behind the ears
cc Blood or other fluids in the ears or nose
cc Confusion or disorientation
cc Changes in level of consciousness
cc Seizures
cc Impaired breathing
cc Impaired vision
cc Nausea or vomiting
cc Partial or complete loss of movement of any body part
cc Loss of balance
cc Behavior similar to that of a person under the influence of alcohol or drugs
(e.g., confusion, stumbling, repeatedly asking the same questions, memory
loss, nausea or vomiting, speech problems)
cc Severe pain or pressure in the head, neck or back (reported by the person,
or indicated by the person holding their head, neck or back)
cc Back pain, weakness, tingling or loss of sensation in the hands, fingers, feet
or toes
cc Persistent headache

TOPIC: I N-WATER SKILL SESSION: Time: 2 hours, 20 minutes
HEAD, NECK AND
SPINAL INJURIES
SKILL PRACTICE: SPINAL INJURIES—SHALLOW WATER
SKILL ■■ Ask participants: What questions do you have about the “Head, Neck
PRACTICE— and Spinal Injuries in the Water” video?
SHALLOW ■■ Explain to participants that during the skill session you will demonstrate skills
WATER: and guide them through practice.
■■ For the first three skills, pair up participants and explain that they will take
turns as victim and rescuer for each skill. For the shallow water backboarding
procedure, divide participants into groups of three—a rescuing lifeguard,
REFERENCES: assisting responder and victim. Each group should practice the backboarding
Course procedure at least two times so that all participants have the opportunity be in
Presentation: the role of rescuing lifeguard.
Slides 145
Participant’s sure to provide any instructions related to their position in the water or how they
Manual:
Chapter 11 should behave as victims.
■■ Prior to the spinal backboarding procedure, remind participants that
backboards, straps and head immobilizers may vary at different facilities. When
employed as a lifeguard, they should expect to be trained on the use of the
backboard as part of a new employee orientation and in-service training.
■■ Lead participants through the following Shallow water skills:
cc Over-Arm Head Splint—Face-Up Victim At or Near the Surface in Shallow
Water
●● Lifeguards: in shallow water
●● Victims: face-up in shallow water, responsive
cc Head Splint—Face-Down Victim At or Near the Surface in Shallow Water

●● Victims: face-down in shallow water, responsive once face-up at surface

cc Spinal Backboarding Procedure—For Facilities with High Edges
■■ Examples of common errors to point out include: rescuers lose contact with
the victim; fails to properly secure victim to the backboard; use of the improper
head splint technique; for a submerged victim—not returning to the surface at
an angle; check for breathing; incorrect strap placement; strap is too tight or too
loose; not placing the victim’s arms on their body; failure to communicate with
the victim.

SKILL PRACTICE: SPINAL INJURIES—DEEP WATER
PRACTICE— ■■ For the Shallow Water Lifeguarding course, omit the skill practice in deep water.
DEEP WATER:
■■ Explain to participants that during the skill session you will demonstrate skills
■■ For the first two skills, pair up participants and explain that they will take turns as
REFERENCES: victim and rescuer for each skill. For the deep water backboarding procedure,
Participant’s
divide participants into groups of three—a rescuing lifeguard, assisting
Manual: responder and victim. Each group should continue to practice the backboarding
Chapter 11 procedure until all participants have had the opportunity to be in the role of
rescuing lifeguard.
■■ Remind participants that the mechanics of the skills are essentially the same
in deep water as in shallow water. The skills are more challenging because
lifeguards are unable to stand to accomplish the skills. A rescue tube can be
used to provide additional support to the rescuing lifeguard.
sure to provide any instructions related to their position in the water or how
they should behave as victims.
■■ Lead participants through the following deep water skills:
cc Head Splint—Face-Down Victim at or Near the Surface in Deep Water
●● Lifeguards: in deep water
●● Victims: face-down in deep water, responsive once face-up at surface
cc Head Splint—Submerged Victim in Deep Water

●● Victims: submerged in deep water, responsive once face-up at surface

●● Victims: face-down in deep water, responsive once face-up at surface
Instructor’s Note: A facility with a low edge is preferred when

practicing the spinal backboarding procedure, but if the facility has
a large gap between the pool edge and the surface of the water,
an additional participant may be used to stabilize the backboard
by holding the backboard (on the opposite side of the rescuing
lifeguard). This allows participants to simulate the technique
for practice. Remind participants that this is not a different
backboarding technique and that the additional participant is not
in the role of an assisting rescuer and should not help to secure or
extricate the victim.
■■ Participants should practice the skills until they are able to meet performance
criteria.
■■ Examples of common errors to point out include: rescuers lose contact with the
victim; failure to properly secure victim to the backboard; using the improper
head splint technique; for a submerged victim—not returning to the surface at
an angle; check for breathing; incorrect strap placement; strap is too tight or too
loose; not placing the victim’s arms on their body; failure to communicate with
the victim.

ASSIGNMENT
ACTIVITY: ■■ Remind participants to prepare for the Lifeguarding Skills Final Written Exam by
reviewing Chapters 1 to 6 and Chapter 11 of the Lifeguarding Manual.
■■ When following the extended outline, instruct participants to complete the
eLearning conclusion which contains the CPR/AED for Professional Rescuers
REFERENCES: and First Aid Final Written Exam.
Course
Presentation:
Slide 146

IN-LINE STABILIZATION—IN-WATER
SKILL CHART: HEAD SPLINT—FACE-UP VICTIM AT OR NEAR THE SURFACE
1. Approach the victim from the side.
■■ In deep water, use the rescue tube under both of your arms for support.
2. Grasp the victim’s arms midway between their shoulder and elbow. Grasp the victim’s right arm
with your left hand and the victim’s left arm with your right hand. Gently move the victim’s arms up
alongside the head.
3. Slowly and carefully squeeze the victim’s arms against their head to help hold the head in line with
the body. Do not move the victim any more than necessary.
4. Quickly look, listen and feel to check for breathing if the victim is unresponsive.
■■ If the victim is not breathing, immediately remove the victim from the water using the passive
victim extrication method and provide resuscitative care. Do not delay removing the victim from
the water by using the spinal backboarding procedure.
■■ If the victim is breathing, hold the victim’s the head in line with the body and move toward safety
until the backboard arrives. In deep water, move the victim to shallow water, if possible.
5. Continuously monitor for responsiveness and breathing. If at any time the victim stops breathing,
immediately remove the victim from the water and then provide appropriate care.

SKILL CHART: HEAD SPLINT—FACE-DOWN VICTIM AT OR NEAR THE SURFACE
1. Approach the victim from the side.
■■ In deep water, use the rescue tube under both of your arms for support.
2. Grasp the victim’s arms midway between the shoulder and elbow. Grasp the victim’s right arm
with your right hand and the victim’s left arm with your left hand. Gently move the victim’s arms up
alongside the head.
3. Squeeze the victim’s arms against their head to help hold the head in line with the body.
4. Glide the victim slowly forward.
■■ Continue moving slowly and turn the victim until they are face-up. To do this, push the victim’s
arm that is closest to you under the water while pulling the victim’s other arm across the surface
toward you.
6. Switch to an overarm head splint position as you near the backboard. Position the victim’s head in
the crook of your arm, with the head in line with the body. To switch to an overarm head splint:
■■ Apply firm pressure with your outside arm to pull the victim toward your chest (hug them in
against your chest).
■■ Release your hand that is holding the arm against your chest and reach over the victim and grab
the victim’s outside arm, placing it next to your other hand.
■■ Release your hand that is under the victim and move it to the victim’s arm that is against your
chest and continue to apply pressure.
7. Continue to check for breathing. If at any time the victim stops breathing, immediately remove the
victim from the water, then provide appropriate care.

SKILL CHART: HEAD SPLINT—SUBMERGED VICTIM
1. Approach the victim from the side. In deep water, release the rescue tube if the victim is more than
an arm’s reach beneath the surface.
2. Grasp the victim’s arms midway between the shoulder and elbow. Grasp the victim’s right arm
with your right hand and the victim’s left arm with your left hand. Gently move the victim’s arms up
alongside the head.
3. Squeeze the victim’s arms against their head to help hold the head in line with the body.
4. Turn the victim face-up while bringing the victim to the surface at an angle. To turn the victim
face-up, push the victim’s arm that is closest to you down and away from you while pulling the
victim’s other arm across the surface toward you. The victim should be face-up just before reaching
the surface or at the surface.
6. Switch to an over-arm head splint position as you near the backboard. Position the victim’s head
close to the crook of your arm with the head in line with the body. Another lifeguard can place a
rescue tube under your armpits to help support you and the victim. To switch to an overarm head
splint:
■■ Apply firm pressure with your outside head to pull the victim toward your chest (hug them in
against your chest).
■■ Release your hand that is holding the arm against your chest and reach over the victim and grab
the victim’s outside arm, placing it next to your other hand.
■■ Release your hand that is under the victim and move it to the victim’s arm that is against your
chest and continue to apply pressure.
SKILL CHART: HEAD SPLINT—FACE-UP IN EXTREMELY SHALLOW WATER
1. Approach the victim’s head from behind. Grasp the victim’s right arm with your right hand and the
victim’s left arm with your left hand, trapping the victim’s head between their arms.
2. Gently move the victim’s arms up alongside their head.
3. Squeeze the victim’s arms against their head to help hold the head in line with the body. Remain
positioned above and behind the victim’s head.
■■ If the victim is not breathing, immediately remove the victim from the water and provide
resuscitative care.
■■ If the victim is breathing, hold the victim in this position. Place a towel or blanket on the victim to
keep them from getting chilled.
Note: If you are unable to keep the victim from getting chilled and there are enough assisting
lifeguards, follow the care steps for skill sheet, Spinal Backboarding Procedure—Speed Slide.

SKILL CHART: HEAD SPLINT—FACE-DOWN IN EXTREMELY SHALLOW WATER
1. Approach the victim from the side. Grasp the victim’s right arm with your right hand and the victim’s
left arm with your left hand, holding the victim’s head between their arms.
2. After the victim’s head is secured between their arms, begin to roll the victim toward you.
3. While rolling the victim, step from the victim’s side toward the victim’s head and begin to turn the
victim face-up.
4. Lower your arm on the victim’s side that is closest to you so that the victim’s arms go over the
top of your arm as you step toward the victim’s head. Maintain arm pressure against the victim’s
head, since your hand rotates during this maneuver. You are now positioned above and behind the
victim’s head.
5. Quickly look listen and feel to check for breathing if the victim is unresponsive.
■■ If the victim is not breathing, immediately remove the victim from the water and provide
resuscitative care.
■■ If the victim is breathing, hold the victim in this position. Place a towel or blanket on the victim to
Note: If you are unable to keep the victim from getting chilled and there are enough assisting
lifeguards, follow the care steps for skill sheet, Spinal Backboarding Procedure and Removal—Speed
Slide.
SKILL ASSESSMENT TOOL: HEAD SPLINT—IN-LINE STABILIZATION FOR A VICTIM IN
THE WATER
Check for responsiveness and ■■ Quickly looks, listens and ■■ Does not look, listen or feel
breathing feels for breathing for breathing
■■ If the victim is not breathing, ■■ If the victim is not breathing,
removes the victim from uses the spinal backboarding
water immediately to provide procedure to extricate the
care using a passive victim victim
extrication technique
Provide in-line stabilization ■■ Moves victim’s arms to a ■■ Does not move victim’s arms
secure position against the against the victim’s head or
victim’s head maintain pressure
■■ Equal pressure on both arms ■■ One arm is pressed against
is maintained throughout head and one is not
rescue
■■ Does not transition to an
■■ Transitions to an overarm overarm head splint (for face-
head splint (for face-down down victims) or does not
victims) while maintaining in- maintain in-line stabilization
line stabilization during the transition
Victim’s face remains out of the ■■ Victim’s face does not ■■ Victim’s face submerges
water submerge under water
■■ Mouth and nose are above ■■ Victim’s mouth or nose is
water under water
Move victim to a safe location to ■■ Moves victim to shallow ■■ Does not move to shallow
prepare for backboarding water if safe and possible water to stand up if it is safe
■■ If rescue involves moving and possible
water, moves victim to a ■■ Remains in moving water
sheltered area when access to a sheltered
area is possible

SPINAL BACKBOARDING AND EXTRICATION FROM WATER
SKILL CHART: SPINAL BACKBOARDING PROCEDURE
1. The rescuing lifeguard provides in-line stabilization using the head splint technique and
swims with the victim toward the side of the pool.
■■ Rotate the victim to a face-up position if necessary. Use the overarm head splint technique to
maintain in-line stabilization before reaching the side of the pool.
2. The assisting responder(s) on deck brings the backboard to the edge of the water and
removes the head immobilizer, placing it within reaching distance.
3. The assisting responder(s) on deck places the board at an angle in the water, submerging
the head space of the board if possible.
4. The rescuing lifeguard now approaches the board and moves to the side of it. The rescuing
lifeguard then places one foot (steps on) the end of the backboard to hold it down.
5. The rescuing lifeguard places the victim on the center of the backboard with the head on the
designated head space.
6. With the head of the backboard resting on the pool edge, the assisting responder stabilizes
the board by pressing down on it with both elbows and stabilizes the victim by placing both
hands on the victim’s arms and applying pressure, using the head splint and the rescuing
lifeguard can release the arms.
■■ A rescue tube may be quickly placed under the foot end of the board, if needed for support.
7. The rescuing lifeguard secures one strap across the victim’s chest, under the armpits, and
then stabilizes the victim by placing one hand and arm on the victim’s chin and chest and the
other hand and arm under the backboard. The assisting responder then releases the victim’s
arms and lowers the victim’s arms down and secures the victim’s head to the backboard
using a head immobilizer and strap across the forehead.
■■ The rescuers should place the victim’s arms on the victim’s torso to prevent discomfort or injury
during extrication.
8. The rescuing lifeguard moves to the foot end of the board while the assisting responder
holds the backboard at the head of the board from the pool deck.
9. The assisting responder lifts the head of the backboard so the runners are on the deck.
10. Working together, the lifeguards pull and push the backboard onto the deck, then begin to
assess the victim’s condition and providing the appropriate care.

SKILL CHART: SPINAL BACKBOARDING PROCEDURE—HIGH EDGES
1. The rescuing lifeguard provides in-line stabilization using the head splint technique and swims with the
victim toward the side of the pool.
■■ Rotate the victim to a face-up position if necessary.
■■ Use the overarm head splint technique to maintain in-line stabilization before reaching the side
of the pool.
2. The assisting responder(s) on deck brings the backboard to the edge of the water and removes the
head immobilizer, placing it within reaching distance.
3. The assisting lifeguard enters the water, submerges the backboard and positions the board under
the victim so that it extends slightly beyond the victim’s head. The victim’s head should be centered
on the backboard’s head space.
4. Once the backboard is in place, the assisting rescuer places a rescue tube under the head end of
the backboard for support and then the assisting responder maintains stabilization of the victim’s
head by placing both hands on the victim’s arms and applying pressure, using the head splint
technique and the rescuing lifeguard can release the arms.
5. The rescuing lifeguard secures the victim to the backboard by securing the chest strap high across
the victim’s chest and under the victim’s armpits. The rescuing lifeguard then stabilizes the victim
by placing one hand and arm on the victim’s chin and chest and the other hand and arm under the
backboard.
6. The assisting responder then releases the victim’s arms and lowers the victim’s arms down and
secures the victim’s head to the backboard using a head immobilizer and strap across the forehead.
7. The rescuing lifeguard gets out of the water and grasps the handholds of the backboard while the
assisting responder maintains control of the backboard from in the water.
8. Working together, the lifeguards pull and push the backboard onto the deck, then begin to assess
the victim’s condition and provide the appropriate care.
SKILL CHART: SPINAL BACKBOARDING PROCEDURE—SPEED SLIDE

1. The rescuing lifeguard (Lifeguard 1) approaches the victim’s head from behind to stabilize the
victim by performing a head splint:
cc Grasp the victim’s right arm with your right hand and the victim’s left arm with your left hand.
Gently move the victim’s arms up to trap the victim’s head between their arms.
cc Squeeze the victim’s arms against their head to help hold the head in line with the body. Remain
positioned above and behind the victim’s head.
2. Check for responsiveness and breathing.
cc If the victim is not breathing, immediately remove the victim from the water and give the
appropriate care.
cc If the victim is breathing, hold the victim in this position. Place a towel or blanket on the victim to
3. Lifeguard 2 positions themselves at the side of the victim, even with the victim’s waist and grasps the
victim at the hip and knee while Lifeguard 3 takes the backboard to the opposite side of the victim.
4. Lifeguard 1 signals to Lifeguard 2 (by counting 1-2-3) to roll the victim to their side; when the
victim is on their side, Lifeguard 3 places the backboard in line with the victim.
5. Lifeguard 1 counts to signal (by counting 1-2-3) and the victim is rolled on to the backboard.
6. Lifeguard 2 secures the victim to the backboard by securing the chest strap high across the
victim’s chest and under the victim’s armpits. Lifeguard 2 then stabilizes the victim by placing one
hand and arm on the victim’s chin and chest and the other hand on the side of the backboard.
7. Lifeguard 1 releases the victim’s arms, lowers the victim’s arms down and secures the victim’s head
to the backboard using a head immobilizer and strap across the forehead.
cc Lifeguard 3 can assist by handing the head immobilizer to Lifeguard 1 and/or placing the
forehead strap on the head immobilizer.
8. Lifeguards lift the backboard and victim out of the slide.
cc When available, additional rescuers can assist with lifting and moving the victim.

SKILL ASSESSMENT TOOL: SPINAL BACKBOARDING PROCEDURE
Maintain in-line stabilization ■■ Rescuing lifeguard maintains ■■ Loss of in-line stabilization
before victim is placed on in-line stabilization while during the rescue
backboard moving the victim toward the ■■ Loss of contact with the
side of the pool victim
water under water
Position the victim on the ■■ Assisting responder(s) on ■■ Assisting responder(s) are

backboard deck bring the backboard to not able to place the board in
the edge of the water and the water and keep it steady
removes head immobilizer ■■ Assisting responder(s) do not
■■ Assisting responder(s) place remove the head immobilizer
the board in the water at an from the backboard before
angle, submerging the head placing the board in the
space of the board water
■■ The rescuing lifeguard ■■ Lifeguards fail to
approaches the board and communicate
moves to the side of the ■■ Victim’s head is not aligned
board while placing the victim on the backboard’s head
on the board space
■■ The victim is placed on the ■■ Victim is not aligned and on
center of the board with the backboard
their head on the designated
headspace
Maintain in-line stabilization ■■ Assisting responder stabilizes ■■ Loss of contact with the
after the victim is placed on the the board and takes over victim or loss of in-line
board in-line stabilization using the stabilization
head splint ■■ Loss of control of the board
Secure strap ■■ Rescuing lifeguard secures ■■ Improper strap placement

one strap high across the ■■ Straps are too loose or too
victim’s chest, under the tight
victim’s armpits
Immobilize the victim’s head ■■ Rescuing lifeguard takes over ■■ Loss of contact with the
in-line stabilization victim
■■ Assisting responder secures ■■ Head immobilizer is not used
the victim’s head to the ■■ Head immobilizer is placed
backboard using a head but moves victim’s head or
immobilizer and strap across neck
the victim’s forehead ■■ No strap is used across the
victim’s forehead
Extricate the victim from the ■■ Lifeguards communicate ■■ Lifeguards fail to
water ■■ Rescuing lifeguard pushes communicate
from the foot of the board ■■ Lifeguards are unable to
while assisting responder remove the victim from the
pulls water
■■ Lifeguards lose control of the
backboard

SKILL ASSESSMENT TOOL: SPINAL BACKBOARDING PROCEDURE—HIGH EDGES
Maintain in-line stabilization ■■ Rescuing lifeguard maintains ■■ Loss of in-line stabilization
before victim is placed on in-line stabilization during the rescue
backboard ■■ Loss of contact with the
victim
water under water
Position the victim on the ■■ Assisting responder in ■■ Assisting responder does not
backboard the water removes head remove the head immobilizer
immobilizer from the ■■ Assisting responder is not
backboard able to submerge the board
■■ Assisting responder in the water and keep it
submerges the backboard steady
under the victim so that it ■■ Victim’s head is not aligned
extends slightly beyond the on the backboard’s head
victim’s head space
■■ The victim is placed on the ■■ Victim is not aligned and on
center of the board with the backboard
their head on the designated
headspace
Maintain in-line stabilization ■■ Assisting responder stabilizes ■■ Loss of contact with the
after the victim is placed on the the board and takes over in- victim or loss of in-line
board line stabilization stabilization
■■ Loss of control of the board
Secure strap ■■ Rescuing lifeguard secures ■■ Improper strap placement
one strap high across the ■■ Straps are too loose or too
victim’s chest, under the tight
victim’s armpits
Immobilize the victim’s head ■■ Rescuing lifeguard takes over ■■ Loss of contact with the
in-line stabilization victim
■■ Assisting responder secures ■■ Head immobilizer is not used
the victim’s head to the
■■ Head immobilizer is placed
backboard using a head but moves victim’s head or
immobilizer and strap across neck
the victim’s forehead ■■ No strap is used across the
victim’s forehead
Extricate the victim from the ■■ Lifeguards communicate ■■ Lifeguards fail to
water ■■ Assisting responder pushes communicate
from the foot of the board ■■ Lifeguards are unable to
while the rescuing lifeguard remove the victim from the
pulls water
■■ Lifeguards lose control of the
backboard

SKILL ASSESSMENT TOOL: SPINAL BACKBOARD PROCEDURE —SPEED SLIDE
Lifeguards communicate as a ■■ Lifeguards communicate ■■ No verbal communication
team to remove the victim from what, how or when actions ■■ Communication does not
the water happen result in effective actions
water under water
Lifeguards remove the ■■ Backboard removed from the ■■ Backboard is lifted in the air,
backboard and victim from water by sliding it along the causing the victim to move or
the water edge slide
■■ Backboard held steady ■■ Backboard is near vertical,
during removal and victim is slipping or
moving
■■ Backboard is jerking or
rocking from side to side

LESSON 9
FINAL WRITTEN EXAM AND FINAL
IN-WATER SKILL SCENARIOS

Add 30 minutes for optional review session
LESSON OBJECTIVES
■■ Demonstrate how to rescue a submerged passive victim in deep water and provide care.
■■ Demonstrate how to rescue a submerged passive victim in shallow water and provide care
(Shallow Water Lifeguarding only).
■■ Demonstrate how to provide care during a multiple-rescuer response for a passive victim.

■■ Final Written Exam: Section 2: Lifeguarding Skills, Exams A and B, and answer sheets—one for
each participant
■■ Answer keys for Final Written Exam: Section 2
■■ Backboards—one for each test group
■■ Adult manikins—at least two so they can be rotated and decontaminated
■■ Adult BVMs—one for each test group
■■ Rescue tubes—one for each test group
■■ AED training unit with adult pads—one for each test group
■■ Timing device, such as a stopwatch or smartphone with a stopwatch feature
LESSON PREPARATION
review questions they completed throughout the course.
■■ To save time, have all the appropriate copies and equipment and materials prepared and
available ahead of time. Copy:
cc Final Exam Section 2—Lifeguarding Skills
cc Final Exam Answer Sheets Section 2—Lifeguarding Skills
cc Multiple-Rescuer Response Scenario Flow Sheets
cc Multiple-Rescuer Response Scenario Assessment Tool

INSTRUCTOR NOTES
■■ When following the extended outline, collect or view participants’ eLearning completion
certificates to ensure completion of all eLearning modules, including the CPR/AED for
Professional Rescuers and First Aid eLearning exam.
■■ Participants must pass the CPR/AED for Professional Rescuers and First Aid eLearning exam
in order for the progress report to show that they successfully completed the conclusion
module of the eLearning.
■■ If a participant does not successfully complete the written exam, they should be counseled to
study further before retaking another version of the written exam.
■■ For the Multiple-Rescuer Response Final Skill Scenario:
cc Each participant is only required to be evaluated successfully in the role of rescuing
lifeguard. Although participants have successfully completed their scenario for evaluation,
they may be needed to rotate into an additional team to have enough rescuers to participate
in the scenario. It is not necessary to evaluate them in the additional role.
cc If an individual receives a “fail” in any skill of the scenario, they receive an overall “fail” rating.
If the team receives a “fail” rating, each lifeguard on the team receives a “fail” rating. It is
possible for the overall team to receive a “pass” rating but one of the lifeguards to receive a
“fail.” If a participant is unsuccessful, they are allowed to re-attempt the scenario.
■■ If a participant is unsuccessful in passing the course, have a private discussion with the
participant about any course objectives that were not met.
TEACHING TIPS
■■ If you have enough equipment and supplies, allow participants to practice team response while
you are conducting the final skills scenarios for other participants.
■■ If you have concerns about the ability of any of the participants to pass the skills scenarios,
consider assigning them to participate in the first scenario in case they need additional practice
to then participate in a retest.
■■ For tips on conducting Multiple-Rescuer Response Scenarios, and for an example of a scenario
where the team is successful but an individual is unsuccessful, see the instructor videos on the

TOPIC: FINAL WRITTEN EXAM: Time: 30 minutes
SECTION 2—LIFEGUARDING SKILLS
FINAL WRITTEN EXAM: SECTION 2—LIFEGUARDING SKILLS
ACTIVITY: ■■ Tell participants that they will now take Section 2 of the final written exam on the
information covered in Chapters 1 through 6 and Chapter 11. They may not use
their manual or notes to find the answers.
■■ Hand out an exam and answer sheet to each participant. Tell participants to put
away all belongings, including mobile devices, and to write only on the answer
sheet and mark answers clearly.

■■ If teaching the Shallow Water Lifeguarding course, hand out Final Written
Exam: Section 2—Shallow Water Lifeguarding Skills and answer sheet to each
participant.
■■ Tell participants to come to you or raise their hand when they have finished the
exam or if they have questions.
■■ Once exams are completed, collect all exams and answer sheets. Grade the
exam using the answer key.
■■ Hand back the exam and review it with participants. Collect all exams again
after the review, as the exam is a standard exam that participants should not be
allowed to keep. Make arrangements for those participants who score less than
80 percent to review the material and retake the alternative version of the exam.
TOPIC: IN-WATER SKILL SESSION: Time: 30 minutes

GENERAL WATER SKILLS (OPTIONAL)
IN-WATER SKILL SESSION: GENERAL WATER SKILLS (OPTIONAL)
ACTIVITY: ■■ This time is allotted for an optional general skills review to meet the needs of
each class. As the instructor, you should set up and facilitate a session to help
participants practice skills before the final skill scenarios.

TOPIC: FINAL IN-WATER SKILL Time: 2 hours, 30 minutes
SCENARIOS
FINAL IN-WATER SKILL SCENARIOS
ACTIVITY: ■■ Tell participants that there are two final skill scenarios.
■■ All skills must be performed according to the proficiency requirements to meet
the objective of the skills.
■■ Each participant has only two opportunities to complete each scenario
successfully.
■■ If a participant does not successfully complete a scenario during the first
attempt, options include:
cc Reattempting the scenario during the normal lesson after a brief consultation
on the corrective actions needed to complete the scenario successfully.
cc If additional practice is needed and time and resources permit, asking
the participant to see you after class to schedule a re-evaluation of the
unsuccessful scenarios at a later time.
■■ To set up each scenario:
cc Assign one participant to simulate the victim behaviors as instructed.
cc Ensure that each lifeguard has a hip pack containing non-latex disposable
gloves and a resuscitation mask.
cc Have a manikin available to substitute into the scenarios for a passive victim
once the primary assessment is complete.
FINAL SKILL SCENARIO 1: SUBMERGED PASSIVE VICTIM IN DEEP WATER
WITH EXTRICATION, PRIMARY ASSESSMENT AND CPR
ACTIVITY: ■■ Explain to participants that this is a timed scenario, not to exceed 1 minute and
30 seconds for the water rescue and extrication (with an assisting lifeguard
who will bring the backboard) and the primary assessment with two ventilations,
followed by 3 minutes of one-rescuer CPR.
cc The rescuing or assisting lifeguard must provide 2 ventilations within
the 1 minute, 30 seconds. The rescuing lifeguard must start CPR chest
compressions just after the ventilations (if he or she did not provide the
ventilations) and continue with one-rescuer CPR.
■■ Divide the participants into groups of three and assign one rescuing lifeguard,
one assisting responder, one victim and a manikin for each group.
■■ Tell the victim to get into position about 30 feet from the edge and submerge as
the rescuing lifeguard gets near.
■■ Start the stopwatch once the EAP has been activated, and again once the
rescuer begins CPR.
■■ Repeat the drill until each participant has performed as a rescuing lifeguard.
■■ The only participant being evaluated for Final Skills Scenario 1 is the lifeguard
assigned to do the water rescue. It is expected this rescuer is evaluated on
performing the water rescue, working with assisting responder on extrication,
assessment and 2 ventilations, and then performing one-rescuer CPR.

■■ For the Shallow Water Lifeguarding course, follow the directions for the
Submerged Passive Victim in Deep Water—Timed Response with the exception
of having the lifeguard and victim stationed in shallow water.

FINAL SKILL SCENARIO 2: MULTIPLE-RESCUER RESPONSE
ACTIVITY:
Instructor’s Note: Each participant is only required to be
evaluated successfully in the role of rescuing lifeguard. Although
participants may have successfully completed their scenario for
evaluation, they may need to rotate into an additional team to have
enough rescuers to participate in the scenario. It is not necessary
to evaluate them in the additional role.
■■ Explain to participants that this is a team scenario and that they are expected
to work with other rescuers and demonstrate clear communication and critical
thinking ability while providing the appropriate care as a part of a team of
multiple rescuers.
■■ Divide participants into groups of five. Assign one person as the victim, but do
not assign other roles such as primary or secondary responder. Instead, assign
two participants as the first to arrive on scene and two participants as the
assisting responders who arrive with the “crash kit” including a BVM and AED.
■■ Tell participants that they will be responsible for prioritizing care, communicating
and taking action. For example, the first responder with gloves on should start
to provide care immediately.
■■ Explain to participants that during this final skills scenario, they will be evaluated
on both:
cc Individual performance and their ability to achieve skill competencies for the
individual skills that they are responsible for.
cc Overall team response performance, demonstrating the ability to work
effectively as part of a team to prioritize care, take action without following an
assigned role and communicate with fellow responders.
■■ For each group, conduct Multiple-Rescuer Response Scenario 3 in Appendix B.
■■ Read the scenario and provide the appropriate prompts (per the scenario flow
sheet) during the scenario.
■■ Use the Multiple-Rescuer Response Assessment Tool for Scenario 3 to
evaluate each individual participant and team performance (Appendix F).
■■ Rotate teams so that each participant has the opportunity to act as the rescuing
lifeguard for evaluation.
Instructor’s Note: If an individual receives a “fail” in any skill

of the scenario, they receive an overall “fail” rating. If the team
receives a “fail” rating, each lifeguard on the team receives a
“fail” rating. It is possible for the overall team to receive a “pass”
rating but one of the lifeguards to receive a “fail.” If a participant is
unsuccessful, they are allowed to re-attempt the scenario.

TOPIC: CLOSING Time: 5 minutes
CLOSING
ACTIVITY: ■■ Thank all participants for attending the course.
■■ Congratulate participants on successful completion.
■■ Explain that they will receive an American Red Cross certificate that indicates
Lifeguarding/First Aid/CPR/AED, valid for 2 years.

■■ For the Shallow Water Lifeguarding course, explain that participants will receive
a certificate that indicates Shallow Water Lifeguarding (up to 5 ft.)/First Aid and
CPR/AED for Lifeguard, valid for 2 years.
■■ Make arrangements to retest any participants who did not pass the final written
exam or scenario(s).

SECTION C | APPENDICES
Appendix A: Sample Letters to Course Participants
Appendix B: Activity Resources
Appendix C: Lifeguarding Video Segments
Appendix D: Common Participant Errors
Appendix E: Participant Progress Logs and Multiple-Rescuer Response Assessment Tools
Appendix F: About the Science
Appendix G: Written Exam Answer Keys and Answer Sheets
Appendix H: Participant’s Manual Chapter Review Answer Keys

APPENDIX A
SAMPLE LETTERS

EMAIL TEMPLATE: NOTIFICATION FOR PARTICIPANTS TO
COMPLETE ELEARNING CONTENT
LIFEGUARDING BLENDED LEARNING INTENSIVE

COURSE
Date:
Dear Lifeguarding Course Participant:
We are excited to offer you American Red Cross Lifeguarding Blended Learning. Blended learning
combines online learning with in-person skills sessions where you will practice skills and demonstrate
competency. Please plan to complete all eLearning modules, including the CPR/AED for Professional
Rescuers and First Aid final eLearning exam, at least two days prior to your first in-person skills
session. Most participants complete the eLearning portion of the course in approximately 7 hours. Your
experience may vary widely based on several factors including your PC, internet speed and previous
training. I recommend beginning the online session as soon as possible to ensure that you are able to
complete all eLearning modules prior to the first in-person skill session.
IN-PERSON SKILLS SESSION SCHEDULE

Precourse Skill Session Date
Precourse Skill Session Time
Course Dates and Times
Location
Once enrolled in the course, you will receive an email from the American Red Cross with instructions
to access and complete the online course content. To get started, log in to the Red Cross Learning
Center, and from your home page click on the class.
All required materials listed below are available as hard copies for purchase at the Red Cross Store; the
store is accessible via a link provided in the Red Cross Learning Center (redcrosslearningcenter.org).
Or, you will be able to download these materials in digital format once you access the online course (at
no cost).

PC/TABLET REQUIREMENTS FOR ONLINE COURSE:
Processor Dual-core processor speed greater than or equal to 2.3GHz
Memory 4 GB
Operating Systems Desktop: Microsoft Windows 7/8/10, OS X Snow Leopard 10.6+
Tablet: iPad iOS 7+ (Safari), Android 4.0.3+ (Google Chrome)
This course is not supported on smartphone devices.
Browsers IE10+, Chrome 49+, Firefox 47+, Safari 9+
Cookies, JavaScript, images and HTML5 audio/video must be
supported
Screen Resolution 1024x768
Color Depth High Color, 32 bit
Bandwidth 2.0 mbps dedicated or faster; broadband Internet access
recommended
Audio Soundcard and either speakers or headpohones for multimedia audio
Please be prepared to provide proof that you completed the required eLearning content prior to each in-
person skill session using one of the following methods.
■■ Print your eLearning module completion record at the conclusion of each eLearning module and bring
it to each in-person skill session.
■■ Be prepared to login to the eLearning course at the beginning of each in-person skill session to
display the module completion status that appears above the “Launch Course” button.
■■ Once you complete the online course, the instructor can view your online completion status.
If you have questions, please contact me directly at ( ) - .
Sincerely,
American Red Cross Instructor

EMAIL TEMPLATE: NOTIFICATION FOR PARTICIPANTS TO
COMPLETE ELEARNING CONTENT
LIFEGUARDING BLENDED LEARNING EXTENDED

COURSE
Date:
Dear Lifeguarding Course Participant:
We are excited to offer you American Red Cross Lifeguarding Blended Learning. Blended learning
combines online learning with in-person skills sessions where you will practice skills and demonstrate
competency. Please plan to complete the initial eLearning lessons of your training at least two days
prior to your first on-site skills session.
IN-PERSON SKILLS SESSION SCHEDULE

Precourse Skill Session Date
Precourse Skill Session Time
Location
IN-PERSON IN-PERSON SKILLS ELEARNING MODULES TO BE

SKILLS SESSION DATE COMPLETED BEFORE ATTENDING THE
SESSION AND TIME IN-PERSON SKILL SESSION
Lesson 1 • Introduction
• The Professional Lifeguard
Lesson 2 • Facility Safety and Patron Surveillance
Lesson 3 • Injury Prevention
Lesson 4 • Water Rescue Skills
Lesson 5 • Before Providing Care and Breathing
Emergencies
Lesson 6 • Cardiac emergencies and Using an AED
Lesson 7 • First Aid
Lesson 8 • Head, Neck and Spinal Injuries
Lesson 9 • Conclusion (includes CPR/AED for Professional
Rescuers and First Aid final eLearning exam)

Once enrolled in the course, you will receive an email from the American Red Cross with instructions
to access and complete the online course content. To get started, log in to the Red Cross Learning
Center, and from your home page click on the class.
All required materials listed below are available as hard copies for purchase at the Red Cross Store; the
store is accessible via a link provided in the Red Cross Learning Center (redcrosslearningcenter.org).
Or, you will be able to download these materials in digital format once you access the online course (at
no cost).
PC/TABLET REQUIREMENTS FOR ONLINE COURSE:

Processor Dual-core processor speed greater than or equal to 2.3GHz
Memory 4 GB
Operating Systems Desktop: Microsoft Windows 7/8/10, OS X Snow Leopard 10.6+
Tablet: iPad iOS 7+ (Safari), Android 4.0.3+ (Google Chrome)
This course is not supported on smartphone devices.
Browsers IE10+, Chrome 49+, Firefox 47+, Safari 9+
Cookies, JavaScript, images and HTML5 audio/video must be
supported
Screen Resolution 1024x768
Color Depth High Color, 32 bit
Bandwidth 2.0 mbps dedicated or faster; broadband Internet access
recommended
Audio Soundcard and either speakers or headpohones for multimedia audio
Please be prepared to provide proof that you completed the required eLearning content prior to each in-
person skill session using one of the following methods.
■■ Print your eLearning module completion record at the conclusion of each eLearning module and bring
it to each in-person skill session.
■■ Be prepared to login to the eLearning course at the beginning of each in-person skill session to
display the module completion status that appears above the “Launch Course” button.
■■ Once you complete the online course, the instructor can view your online completion status.
If you have questions, please contact me directly at ( ) - .
Sincerely,
American Red Cross Instructor

APPENDIX B
ACTIVITY RESOURCES
Multiple-Rescuer Response Scenario Flow Sheets

201
SCENARIO 1 FLOW SHEET
An adult has collapsed in the hallway. Two rescuers are on the scene. The EAP has been activated and EMS personnel have been called. Additional
rescuers are on the way with additional equipment—an AED and a BVM. The victim appears to be unresponsive.
Description/Instructor Notes Actions Instructor Prompt
Read scenario #1 (above).
The adult (manikin) is lying on the floor on their • One responder shouts-taps-shouts to see if person is “There is no response.”
back and appears unresponsive. responsive.
• Both responders get gloves on and get resuscitation
masks ready.
The first rescuer with gloves on should start the • One responder opens the airway and simultaneously “There is no breathing and no
primary assessment. checks for breathing and pulse no longer than 10 pulse.”
seconds.
• The responder then communicates that there’s no
pulse and starts CPR.
Responders perform two-rescuer CPR. • One responder begins CPR starting with 30 chest
compressions.
Lifeguarding | Blended Learning Instructor’s Manual

• The other responder is in position with the
resuscitation mask ready to give ventilations.
• After the 30th compression, the responder gives two
quality ventilations.
• The two responders continue two-rescuer CPR.
At the start of five cycles of CPR (approximately • The responder doing compressions calls for a change After a few compressions, prompt the
2 minutes), two additional rescuers arrive with on their fifth cycle of compressions. two additional responders to arrive with
the “crash bag,” which contains a BVM and an additional equipment (BVM and AED).
AED. • At the end of the fifth cycle, the compressor and
ventilator change positions and continue CPR.
The first rescuer with gloves on attaches the • One responder attaches the BVM to the mask and
BVM to the resuscitation mask. squeezes the bag during ventilations.
•O
ne responder prepares and applies the AED while
CPR is in progress.
• Once the AED is ready to analyze, the responder
calls to clear for the AED to analyze.
202
SCENARIO 1 FLOW SHEET, CONTINUED
The AED analyzes and responders change • All responders pause CPR and clear out. “AED advises to shock.”
positions. • The responder doing compressions changes
positions with another responder.
• The “new compressor” hovers hands a few inches
above the chest during analysis to prepare for CPR.
Shock is advised. • One responder (AED operator) pushes the shock “AED prompts ‘Continue CPR.’”
button. (Responders should start CPR without
waiting for the prompt.)
Continue CPR for five cycles (approximately 2 • One responder gives compressions and calls for a
minutes). change at the beginning of the fifth cycle.
• One responder maintains the airway and an adequate
seal on the resuscitation mask.
• One responder operates the BVM by squeezing the
bag for ventilations.
• One responder is ready to operate the AED and to
change positions as needed.

The AED analyzes and responders change • At the end of the fifth cycle, once the AED is ready to “AED prompts ‘No shock advised,’
positions. analyze, the responder calls to clear for the AED to followed by ‘Continue CPR.’”
analyze. (Responders should start CPR without
•
The position change should not take longer than All responders pause CPR and clear. waiting for the prompt.)
5 seconds. • The responder doing compressions changes
Continue CPR for five cycles (approximately 2 • One responder gives compressions.
minutes). • One responder maintains the airway and a good seal
on the resuscitation mask.
change positions with the compressor as needed.
EMS has arrived on scene and is ready to take “EMS is on scene and is ready to
over care of the victim. take over care of the victim.”
203
An infant victim has just been rescued from the water. The victim appears unresponsive. Four rescuers are on the scene with an AED and BVM. The
EAP has been activated, EMS personnel have been called.
Instructor’s Note: Consent is implied for a drowning victim. For this scenario, assume that the victim has already been rescued from the
water. Participants are not required to complete a water rescue.

Four responders are on the scene with the • One responder shouts-taps-shouts to see if infant is “There is no response.”
“crash kit” as the infant has just been extricated responsive.
from the water. • Both responders get gloves on and get resuscitation
masks ready.
The first responder with gloves on does a • One responder opens the airway and quickly checks “There is no breathing and no
primary assessment and starts CPR. for breathing and pulse simultaneously for no longer pulse.”
than 10 seconds.
• The responder communicates no pulse and no “Air does not go in.”
breathing.
• The responder then attempts ventilations. “Air still does not go in.”
• The responder re-tilts and attempts another

ventilation; it does not go in.
Three responders do CPR and the fourth • One responder starts compressions.
prepares the AED to analyze. • One responder maintains the airway.
• One responder attaches the BVM to the mask and is
prepared to operate the BVM.
• One responder is preparing the AED while CPR is in
progress.
Responder checks for an object in the mouth. • One responder looks for an object in the mouth. “No object is seen.”
(Ideally, the responder who was squeezing the
bag.)
Victim vomits after a ventilation attempt. • One rescuer gives a ventilation and the infant vomits. “Vomit in the mouth.”
• The responders roll the infant on to their side and
clear the infant’s mouth of vomit with a finger sweep “Mouth is clear.”
(or suction if available).
204
Roll the victim on their back and continue CPR • One responder starts compressions.
for one cycle. • One responder maintains the airway and an adequate
bag during ventilations.
progress.
The AED is ready to analyze. • One responder calls for and ensures all are clear for
the AED to analyze.
The AED analyzes and responders change • All responders are clear.
• The “new compressor” prepares to take over
compressions.
Shock is advised. • One responder (AED operator) pushes the shock “After the shock, AED prompts
button. ‘Continue CPR.’”

(Responders should start CPR without
minutes) then end the scenario. • One responder maintains the airway and an adequate
The infant begins to cough and opens their • Responders place the infant in a recovery position. “The infant begins to cough and
eyes. opens their eyes.”
205
An adult victim is submerged in the deep end. Two rescuers are on the scene. The EAP has been activated, EMS personnel have been called and
additional rescuers are on the way with additional equipment—an AED and a BVM.
Instructor’s Note: For this scenario, assign the rescuing lifeguard and the assisting responder. The rescuing lifeguard should perform an
entry, approach the victim, perform the appropriate passive victim rescue and work with the assisting responder to extricate the victim. The
victim should get into position and submerge as the rescuing lifeguard approaches. Substitute a manikin for the victim after extricating the
victim from the water.
An adult victim is submerged in the deep end. • One responder performs a submerged victim rescue. “Move to manikin.”
• Another responder brings the backboard and assists
with extricating the victim from the water.
The adult is on their back on the backboard and • One responder shouts-taps-shouts to see if person is “There is no response.”
appears unresponsive. responsive.
• Both responders get gloves on and get resuscitation
masks ready.
The first rescuer with gloves on should start. • One responder opens the airway and quickly checks “There is no breathing and no
for breathing and pulse no longer than 10 seconds. pulse.”
• The responder communicates no pulse and no

breathing.
• The responder then gives two quality ventilations.
• The other responder starts CPR beginning with 30
chest compressions.
• The two responders continue two-rescuer CPR.
At the start of two cycles of CPR, two additional • CPR continues. After a few compressions, prompt the
rescuers arrive on the scene with the “crash • One responder assembles the BVM and assists with two additional rescuers to arrive with
bag” with a BVM and an AED. giving ventilations. additional equipment (BVM and AED).
• One responder prepares and applies the AED while
The first additional rescuer with gloves on CPR is in progress.
assembles the BVM and assists with giving
ventilations.
206
The AED is ready to analyze. •O ne responder calls for and ensures all are clear for
the AED to analyze.
The AED analyzes and responders change • All responders are clear.
Shock is advised. • One responder (AED operator) pushes the shock “After the shock, the AED indicates
button. to continue CPR.”
minutes). • One responder maintains the airway and an adequate

The AED analyzes and responders change • All responders pause CPR and clear. “AED prompt indicates no shock
positions. • The responder doing compressions changes advised and then to continue CPR.”
positions with another responder. (Responders should start CPR without
• The “new compressor” hovers hands a few inches waiting for the prompt.)
EMS has arrived on scene and is ready to “EMS is on scene and is ready to
assume care of the victim. take over care of the victim.”
207
A child victim is submerged in the deep end and appears to be unresponsive. Four rescuers are on the scene on the deck with an AED and BVM. The EAP has been activated and
EMS personnel have been called.
Instructor’s Note: Consent is implied for the drowning victim. For this scenario, assign the rescuing lifeguard and the assisting responder. The rescuing lifeguard
should perform an entry, approach the victim, perform the appropriate passive victim rescue and work with the assisting responder to extricate the victim. The victim
should get into position and submerge as the rescuing lifeguard approaches. Substitute a manikin for the victim after extricating the victim from the water.

A child victim is submerged in the deep end. • One responder performs a submerged victim rescue. “Move to manikin.”
• Another responder brings the backboard and assists with
extricating the victim from the water.
Four responders are on the scene with the • One responder shouts-taps-shouts to see if person is “No response.”
“crash kit” as the child has just been extricated responsive.
from the water. • All responders get gloves on and prepare equipment
(masks, BVM, AED).
The first responder with gloves on does a • One responder opens the airway and simultaneously “No breathing and no pulse.”
primary assessment and starts CPR. checks for breathing and pulse no longer than 10 seconds.
• The responder communicates no pulse and no breathing.
• The responder then gives two quality ventilations.
The other responders attach the BVM and • One responder gives 15 chest compressions.

assist with ventilations and prepare the AED to • One responder maintains the airway and an adequate seal
analyze. on the resuscitation mask.
• One responder operates the BVM by squeezing the bag
for ventilations.
• One responder prepares and applies the AED while CPR
is in progress.
The AED is ready to analyze. • One responder calls for and ensures all are clear for the
AED to analyze.
The AED analyzes and change of positions. • All responders are clear.
• The responder doing compressions changes positions with
another responder.
• The “new compressor” hovers hands a few inches above
the chest during analysis to prepare for CPR.
Shock is advised. • One responder (AED operator) pushes the shock button. “After the shock, the AED indicates
to continue CPR.”
208
Continue CPR for five cycles (approximately 2 • One responder gives compressions. “AED prompt indicates no shock
minutes). • One responder maintains the airway and an adequate seal advised and then to continue CPR.”
on the resuscitation mask. (Responders should start CPR without
• One responder operates the BVM by squeezing the bag waiting for the prompt.)
for ventilations.
• One responder is ready to operate the AED and to change
positions as needed.
The AED analyzes and responders change • All responders pause CPR and clear.
positions. • The responder doing compressions changes positions with
another responder.
• The “new compressor” hovers hands a few inches above
the chest during analysis to prepare for CPR.
No shock advised • One responder (AED operator) pushes the shock button. “AED prompt indicates no shock
advised and then to continue CPR.”
Continue CPR. During the first set of • One responder gives compressions but stops when the When the compressor gets to their eighth

compressions, the victim vomits. victim vomits. compression, say: “The victim vomits.”
• The rescuers roll the victim on their side.
• One rescuer clears the mouth of vomit with a finger sweep. After the rescuer clears the victim’s
(Use suction if available.) mouth, say: “The vomit has been
cleared.”
After the mouth is clear, the victim is rolled to • The rescuers roll the victim on their back to continue CPR
their back to continue care. starting with compressions.
CPR continues starting with compressions. • One responder gives compressions. First attempt at ventilation, say: “Air does
At the first attempt at ventilations, air does not • One responder maintains the airway and an adequate seal not go in.”
go in. They retilt and air goes in; they continue on the resuscitation mask and re-tilts the head when air
CPR for another two cycles. doesn’t go in on the first attempt.
After re-tilt, say: “Air goes in.”
• One responder attempts a ventilation that does not go in.
• One responder attempts another ventilation and the air
goes in.
• The team continues CPR.
EMS arrives and assumes care for the victim. “EMS arrives and assumes care for
the victim.”
209
A child is submerged in deep water and appears to be unresponsive. The lifeguard that assists with extrication will need to leave the scene to call 9-1-1 and call for additional
responders and equipment.
Instructor’s Note: Consent is implied for the drowning victim. For this scenario, assign the rescuing lifeguard and the assisting responder. The rescuing lifeguard
should perform an entry, approach the victim, perform the appropriate passive victim rescue and work with the assisting responder to extricate the victim. The victim
should get into position and submerge as the rescuing lifeguard approaches. Substitute a manikin for the victim after extricating the victim from the water.
Description Actions Instructor Prompt

One responder is on the scene—the other • The responder shouts-taps-shouts to see if the child “There is no response.”
lifeguard has gone to go call 9-1-1 and call for is responsive.
more assistance (additional lifeguards) at the • The responder gets gloves on.
facility. The lifeguard on scene should start care
alone.
One responder checks for breathing and a • The responder opens the airway and checks for breathing “There is no breathing and no
pulse. and a pulse simultaneously for no more than 10 seconds. pulse.”
One-responder CPR continues for 2 cycles and • The responder gives two quality ventilations. Prompt one assisting rescuer to arrive.
then an additional responder shows up on the • The responder continues one-rescuer CPR, giving 30
scene and indicates that 9-1-1 has been called compressions and two ventilations for two cycles.

and additional responders are on their way with
the AED and BVM.
Continue CPR and incorporate an additional • The assisting responder gets their gloves on (if not already
rescuer. on).
• Both responders begin two-rescuer CPR, giving 15
compressions and two ventilations.
• The compressor calls for a change at the beginning
of the fifth cycle.
Change of position and continue CPR. • The compressor moves to a position to do ventilations and
the other responder is in position to give compressions.
• The two responders continue with two-rescuer CPR.
After a few compressions, two additional • One responder gives 15 compressions. Prompt the two additional rescuers to
responders show up on the scene with the • One responder maintains the airway and an adequate seal arrive with the BVM and AED.
“crash kit” with a BVM and an AED. Continue on the resuscitation mask.
CPR, incorporating the BVM while the AED is • One responder attaches the BVM to the mask and is
being prepared. prepared to operate the BVM.
progress.
210
the AED to analyze.
The AED analyzes and responders change • All responders are clear. “AED prompts to shock.”
Continue CPR for 5 cycles (approximately 2 • One responder gives compressions.
minutes) then end the scenario. • One responder maintains the airway and an adequate

EMS arrives. “EMS arrives and assumes care of
the victim.”
211
A patron has run into the pool office to report an adult has collapsed in the locker room and is requesting help with the emergency. A lifeguard supervisor is the first to arrive on the
scene and discovers that the victim is unresponsive.

The supervisor performs a primary assessment. • The supervisor gets gloves on. “No breathing and no pulse.”
• The supervisor opens the airway and checks for
breathing and a pulse simultaneously for no more
than 10 seconds.
Two lifeguards have just responded with the • The responders get gloves on. Prompt additional rescuers to arrive with
“crash bag,” which includes an AED and BVM, the BVM and AED.
and brought it to the locker room.
The supervisor determines that there is no • Tells the lifeguards there is no breathing and no pulse “There is no breathing and no
breathing or pulse. One lifeguard leaves the and to go call 9-1-1 and report back. pulse.”
scene to call 9-1-1 and the other prepares the • One lifeguard leaves to call 9-1-1.
AED. • The supervisor begins CPR starting with 30
compressions.
• The other lifeguard prepares the AED.

the AED to analyze.
The AED analyzes and change of positions is • Both responders are clear.
signaled. • The responder doing compressions changes
Shock is advised. • The supervisor (AED operator) pushes the shock “After the shock, the AED indicates
212
The other lifeguard arrives and indicates that • One responder gives 30 compressions.
EMS personnel are on the way. • The supervisor maintains the airway and an adequate
Continue CPR for five cycles (approximately 2 • One responder attaches the BVM to the mask and is
minutes). prepared to operate the BVM.
the AED to analyze.
The AED analyzes and responders change • All responders are clear. “AED prompts to shock.”

EMS arrive. “EMS arrives and assumes care of
the victim.”
APPENDIX C
LIFEGUARDING VIDEO SEGMENTS

LIFEGUARDING VIDEO SEGMENTS
* Video is included in eLearning content.
Lesson 1: The Professional Lifeguard and Facility Safety

■■ The Professional Lifeguard (3:38) *
■■ The Unprofessional Lifeguard (3:59) *
■■ Entries and Approaches (6:17) *
Lesson 2: Facility Safety, Patron Surveillance and Injury Prevention

■■ Not on Your Watch (3:55) *
■■ Surveillance (8:03) *
■■ Scanning (5:22) *
■■ Zones of Surveillance (8:06) *
■■ Injury Prevention (3:54) *
Lesson 3: Injury Prevention and Rescue Skills, Part 1

■■ Emergency Action Plans (5:45) *
■■ Water Rescue Skills—Rescues At or Near the Surface (9:20) *
Lesson 4: Rescue Skills, Part 2

■■ Review—Surveillance Activity 1 (3:22)*
■■ Water Rescue Skills—Submerged Victim Rescues (4:52) *
■■ Extrications (7:23) *
Lesson 5: Before Providing Care, Victim Assessment and Breathing Emergencies

■■ Standard Precautions (3:24) *
■■ Primary Assessment (6:42) *
■■ Giving Ventilations (4:03) *
■■ Using a Bag-Valve-Mask Resuscitator—Two Rescuers (1:34) *
■■ Conscious Choking—Adult and Child (2:01) *
■■ Conscious Choking—Infant (1:19) *
Lesson 6: Cardiac Emergencies and Using an Automated External Defibrillator

■■ Heart Attack and the Cardiac Chain of Survival (3:12) *
■■ CPR—Adult and Child 6:28) *
■■ CPR—Infant (2:16) *
■■ Two-Rescuer CPR—Adult and Child (2:42) *
■■ Two-Rescuer CPR—Infant (1:47) *
■■ Using an AED (2:19) *
■■ Using an AED—CPR in Progress (1:17) *
■■ CPR—Obstructed Airway (3:40) *
■■ Putting It All Together—Multiple Rescuer Response (2:07)

Lesson 7: First Aid
■■ Review—Surveillance Activity 2 (5:42) *
■■ Responding to Sudden Illnesses (7:46) *
■■ Responding to Injuries (7:47) *
■■ Head, Neck and Spinal Injuries on Land (1:49) *
■■ When Things Do Not Go as Practiced (2:46)
Lesson 8: Head, Neck and Spinal Injuries in the Water

■■ Head, Neck and Spinal Injuries in the Water (12:51) *
Waterfront Rescue Skills (13:21)
Waterpark Rescue Skills (7:01)
Aquatic Attractions Lifeguarding

■■ Extrications (7:10)
■■ When Things Do Not Go as Practiced (2:49)
■■ Head, Neck and Spinal Injuries in the Water (13:41)
Administering Emergency Oxygen

■■ Using a Resuscitation Mask (2:29)
■■ Using a Bag-Valve-Mask Resuscitator—Two Rescuers (1:34)
■■ Oxygen Delivery (3:47)
■■ Using a Manual Suctioning Device (0:57)
■■ Using a Mechanical Suctioning Device (1:59)
Bloodborne Pathogens Training: Preventing Disease Transmission

■■ How Infections Occur (5:26)
■■ The Exposure Control Plan (2:10)
■■ Personal Protective Equipment (2:01)
■■ Engineering and Work Practice Controls (3:47)
■■ Exposure Incidents (1:56)
Anaphylaxis and Epinephrine Auto-Injector Training

■■ Assisting with an Epinephrine Auto-Injector (4:11)
Asthma Inhaler Training © 2011, 2017, 2019 The American National Red Cross. All rights reserved.
■■ Assisting with an Asthma Inhaler (2:57)

APPENDIX D
COMMON PARTICIPANT ERRORS

COMMON PARTICIPANT ERRORS
Lesson Examples of Common Errors

3 Active Victim Front Rescue:
■■ Not keeping straight arms throughout
■■ Pushing the victim onto their back
■■ Not having the victim lean forward on the tube to stay up
3 Active Victim Rear Rescue:

■■ Not communicating with the victim after making contact
■■ Trying to put the active victim into a vertical position
■■ Trying to put them completely on their back
3 Passive Victim Front Rescue:

■■ Grasping the victim’s arm in the incorrect place (topside instead of underside)
■■ Unable to easily turn the victim face-up by pulling and twisting the arm
■■ Not pushing the tube (with a straight arm) under the victim’s back during the turn
■■ Letting go of one arm before in position to tow
■■ Victim’s head not in an open airway position during the tow
■■ Not reaching over the tube for the tow
■■ Not hooking the towing arm tight during the tow
3 Passive Victim Rear Rescue:

■■ Not reaching over the tube for the tow, not hooking the towing arm tight during the tow
3 Multiple Victim Rescue:

■■ Not supporting the victim’s head above water
4 Passive Submerged Victim—Shallow Water:

■■ Taking the rescue tube off completely
4 Feet-First Surface Dive:

■■ Positions that promote buoyancy rather than support submerging if the person is not
submerging
■■ Hold the breath
■■ Looking straight ahead or up toward the surface
■■ Using legs in a way to move to the surface such kicking
■■ Movements that fight submerging—legs spread not streamlined
■■ Not using sweeping arm movements to assist submerging
4 Head-First Surface Dive:

■■ Positions that promote buoyancy rather than support submerging if the person is not
submerging
■■ Holding the breath
■■ Not looking down toward the target
■■ Looking up toward the surface
■■ Not using sweeping arm movements to assist submerging

4 Passive Submerged Victim—Deep Water:
■■ Does not submerge to a position “standing” behind the victim (heel to toes)
■■ Does not grasp arm around the victim’s chest
■■ Does not feed the tube strap into their hand as they move toward the surface
■■ Unable to get the tube under the victim’s back before breaking the surface
4 Extrication Using a Backboard at the Pool Edge:

■■ Does not submerge board deep enough
■■ Does not angle board once submerged to assist loading the victim
■■ Does not control the board and the victim
■■ Loses contact with the victim
■■ Does not keep the board low during removal
■■ Drops the board after removal
5 Performing a Primary Assessment:

■■ Failing to size up the scene
■■ Failing to determine responsiveness (infant: shout-tap-shout by tapping the foot)
■■ Failing to follow standard precautions
■■ Improperly opening the airway
■■ Checking an inappropriate pulse site (infant: not checking the brachial pulse site)
■■ Not looking at the chest while checking for breathing
5 Using a Resuscitation Mask:

■■ Improperly opening the airway
■■ Not obtaining a seal with the resuscitation mask, or not making the chest rise and fall
■■ Not looking at the chest while checking for breathing
5 Giving Ventilations—Adult and Child:

■■ Not tilting the head
■■ Tilting the head too far back
■■ Failing to reassess for breathing and pulse
■■ Not looking at the chest when assessing for breathing
■■ Not noticing if the ventilations are inadequate (don’t cause the chest to rise)
■■ Providing ventilations at the incorrect ratio
■■ Breathing too hard or too soft
■■ Not obtaining a seal with the resuscitation mask or using an improperly sized mask for
the victim
■■ Not counting out loud

5 Giving Ventilations—Infant:
■■ Not tilting the head
■■ Tilting the head past a neutral position
■■ Failing to recheck for breathing and a pulse
■■ Checking an inappropriate pulse site
■■ Giving ventilations that are too hard or at the wrong rate
■■ Not properly sealing the resuscitation mask
■■ Not looking at the chest when checking for breathing or not using a pediatric mask for
the infant victim
5 Giving Ventilations Using a Bag-Valve-Mask Resuscitator—Two Rescuers:

■■ Maintaining a seal with the resuscitation mask
■■ Not squeezing the bag hard enough or squeezing the bag too hard
5 Conscious Choking:
■■ Failing to obtain the victim’s consent
■■ Performing abdominal thrusts before back blows
■■ Positioning the hands improperly
■■ Not using the thumb side of the fist to give abdominal thrusts
6 CPR—Adult, Child and Infant:

■■ Compressions that are too shallow or too deep
■■ Interrupting compressions for too long or too frequently
■■ Incorrect hand position
■■ Failure to allow full recoil after each compression or inappropriate rate (speed) of
compressions
■■ Incorrect rate of compressions and ventilations
■■ Inadequate ventilations
■■ Not keeping straight arms/locking elbows
6 Two-Rescuer CPR—Adult and Child:

■■ Compressions that are too shallow or at an appropriate rate
■■ Compressing and ventilating at the same time
■■ Failing to call for a position change or using an incorrect cycle of compressions and
ventilations
6 Two-Rescuer CPR—Infant:
■■ Compressions that are too shallow or at an inappropriate rate
■■ Failing to use the encircling thumbs technique
ventilations

6 Two-Rescuer CPR—Infant:
■■ Compressions that are too shallow or at an inappropriate rate
■■ Failing to use the encircling thumbs technique
ventilations
6 Using an AED:
■■ Not wiping the victim’s chest
■■ Using pediatric AED pads on an adult or failing to resume CPR after delivery of a
shock or incorrect CPR performance
6 CPR with Airway Obstruction:
■■ Using abdominal thrusts instead of chest compressions
■■ Failing to check the mouth for an object
■■ Performing a blind finger sweep
■■ Compressing too little or too much
■■ Failing to give ventilations or using the wrong finger to clear the object from the mouth
■■ Incorrect compression to ventilation ratio
8 Over-Arm Head Splint—Face-Up at the Surface:

■■ Not keeping the head above water
■■ Not firmly splinting the head
■■ Allowing the head to fall backwards
■■ Allowing the victim to run into swimmers or objects
8 Head Splint—Face-Down at or Near the Surface:

■■ Not switching to an over-arm head splint when nearing the board
8 Head Splint—Submerged Victim:

■■ Not returning to the surface at an angle
■■ Allowing the airway to become submerged after returning to the surface
8 Spinal Backboarding—Deep Water:

■■ Switching to the over-arm head splint too far away from the board and struggling
■■ Assisting rescuer does not place the rescue tube under the rescuer’s arms for support

8 Spinal Backboarding Procedure:
■■ Rescuers lose contact with the victim
■■ Does not angle the board deep enough for easy loading
■■ Does not switch to or use the over-arm head splint as nearing the board
■■ Failure to properly secure victim to the backboard
■■ No quick check for breathing
■■ Incorrect strap placement
■■ Not placing the victim’s arms on their body
■■ Failure to communicate with the victim
■■ No access to, or too far away from, the head blocks and head strap
■■ Failure to maintain stabilization throughout
■■ Does not keep the board low to the ground during removal
8 Spinal Backboarding Procedure—High Edges:

■■ Both rescuers not in the water
■■ Unable to submerge the board under the victim for loading
■■ Rescuers lose contact with the victim
■■ Does not switch to or use the over-arm head splint as nearing the board
■■ Failure to properly secure victim to the backboard
■■ No quick check for breathing
■■ Incorrect strap placement
■■ Not placing the victim’s arms on their body
■■ Failure to communicate with the victim
■■ No access to, or too far away from, the head blocks and head strap
■■ Failure to maintain stabilization throughout
■■ Does not keep the board low to the ground during removal
8 Spinal Backboarding and Extrication—Speed Slide:

■■ Rescuers not lifting the victim at the same time during removal
■■ Not calling for the slide to be turned off
■■ Allowing the victim’s airway to become submerged
8 Waterfront/Rescue Board Skills:

■■ Allowing the victim’s airway to remain submerged when flipping the board
■■ Running into the victim with the board
■■ Having the board on the wrong side when starting to move the victim onto the board

APPENDIX E
PARTICIPANT PROGRESS LOG
Participant Progress Log
Multiple-Rescuer Response Assessment Tool

Participant Progress Log
NAME OF PARTICIPANT
10.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Skills
Slide-In Entry and Walking Approach
Slide-In Entry and Swimming Approach
Stride Jump and Swimming Approach*
Compact Jump and Swimming Approach
Reaching Assist from the Deck
Simple Assist
Active Victim Front Rescue
Active Victim Rear Rescue
Passive Victim Front Rescue
Passive Victim Rear Rescue
Multiple Victim Rescue
Passive Submerged Victim in Shallow Water
Feet-First Surface Dive in Deep Water*
Head-First Surface Dive in Deep Water*

NAME OF PARTICIPANT
10.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Skills
Successfully Completed eLearning Content
Submerged Victim in Deep Water*
Extrication Using a Backboard at the Pool

Edge
Extrication Using a Backboard at the Steps
(optional)
Removing Disposable Gloves
Performing a Primary Assessment and

Recovery Position—Adult
Using a Resuscitation Mask—Head-Tilt/

Chin-Lift Technique
Using a Resuscitation Mask—Jaw-Thrust
(with Head Extension) Maneuver
Using a Resuscitation Mask—Jaw-Thrust

(without Head Extension) Maneuver
Performing a Primary Assessment and
Recovery Position—Infant
Giving Ventilations—Adult
Giving Ventilations—Infant
Giving Ventilations Using a Bag-Valve-Mask—

Two Rescuers
Conscious Choking—Adult
Conscious Choking—Infant
One-Rescuer CPR—Adult
One-Rescuer CPR—Infant

NAME OF PARTICIPANT
10.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Skills, continued
Two-Rescuer CPR—Adult
Two-Rescuer CPR—Infant
Using an AED and Using an AED—CPR in

Progress
CPR with Airway Obstruction—Adult
CPR with Airway Obstruction—Infant
Controlling External Bleeding
Front Head-Hold Escape
Rear Head-Hold Escape
In-Water Ventilations—Shallow Water
In-Water Ventilations—Deep Water*
Over-Arm Head Splint—Face-Up Victim in © 2011, 2017, 2019 The American National Red Cross. All rights reserved.
Shallow Water
Head Splint—Face-Down Victim at or near

the Surface in Shallow Water
Spinal Backboarding Procedure (Shallow

Water)
Spinal Backboarding Procedure—High Edges
Head Splint—Face-Down Victim at or near

the Surface in Deep Water*

NAME OF PARTICIPANT
10.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Skills, continued
Head Splint—Submerged Victim in Deep Water*
Spinal Backboarding Procedure (Deep Water)

Response Scenarios 1–6
FINAL WRITTEN EXAMS
Final Written Exam: Section 1—CPR/AED
for Professional Rescuers and First Aid
(completed in eLearning conclusion for
blended learning)
Final Written Exam: Section 2—Lifeguarding
Skills*
Final Written Exam: Section 2—Shallow
Water Lifeguarding
FINAL SKILL SCENARIOS

Submerged Passive Victim—Timed Response
Multiple-Rescuer Response Scenario 3
Items noted with an asterisk (*) are required for the Lifeguarding course only.

SCENARIO 1—MULTIPLE-RESCUER RESPONSE ASSESSMENT TOOL
Lifeguard Multiple-Rescuer Response Scenarios includes a rating of “Pass” or “Fail” for each lifeguard participating. Evaluate participants using this tool to help them
229
prepare for the final skills scenario.
• During the final skills scenario, a “Pass” rating indicates that during the skills evaluation, the lifeguard successfully completed the skills they performed. A “Pass” rating for the team indicates the
team met the objective for the overall team response.
• A “Fail” rating indicates that the lifeguard did not successfully complete one or more of the skills they performed. If a lifeguard receives a “Fail” rating in any skill of the scenario, they receive
an overall “Fail” rating. If the overall team response receives a “Fail” rating, each lifeguard on the team receives a “Fail” rating. It is possible for the overall team response to pass but one of the
individual lifeguards to fail.
AN ADULT HAS COLLAPSED IN A HALLWAY Responder Names and Ratings
Name Name Name Name
Competencies
Teamwork and Communication: Accurately and effectively communicated with fellow responders
Communication
Coordination: Clearly and decisively rotated through roles throughout scenario
Feedback: Able to clearly provide guidance to teammates to self-correct as needed
Overall—Teamwork and Communication
Chest Compressions Location: Hands centered on the lower half of the sternum
Depth: At least 2 inches
Recoil: Allow full chest recoil between compressions

Rate: 30 compressions at a rate of 100 to 120 per minute
Overall—Chest Compressions
Ventilations and BVM BVM: Connects appropriate sized BVM and resuscitation mask
Length: Each ventilation should be 1 second in duration
Visual: Chest should clearly rise
Ratio: Two ventilations
Overall—Ventilations and BVM
AED Preparation: Turn on the AED; plug in the connector, if necessary
Location: Correct pad placement; place one pad on the victim’s upper right chest
and the other pad on the left side of the chest
Time: Minimizes interruptions during rotation; should be less than 5 seconds
Compressor Position: Hovers during AED analysis
Overall—AED
Scenario 1 Overall Team Response
Lifeguard Multiple-Rescuer Response Scenarios includes a rating of “Pass” or “Fail” for each lifeguard participating. Evaluate participants’ using this tool to help them
230
AN INFANT HAS JUST BEEN RESCUED FROM THE WATER Responder Names and Ratings
Name Name Name Name
Competencies
Teamwork and Communication: Accurately and effectively communicates with fellow responders
Communication Coordination: Clearly and decisively rotates through roles throughout scenario
Primary Assessment Initial Ventilations: Gives two successful ventilations for a victim who is
and Chest unresponsive as a result of a drowning
Compressions Location: Two thumbs centered on the sternum just below the nipple line with fingers
encircling the chest
Depth: About 1 ½ inches

Location: Correct pad placement; place one pediatric pad on the center of the chest
and one pad on the center of the infant’s back
Overall—AED
MULTIPLE-RESCUER RESPONSE SCENARIO 3—AND FINAL SKILL SCENARIO—ASSESSMENT TOOL
• During the final skills scenario, a “Pass” rating indicates that during the skills evaluation, the lifeguard successfully completed the skills they performed. A “Pass” rating for the team indicates the team met
231
the objective for the overall team response.
• A “Fail” rating indicates that the lifeguard did not successfully complete one or more of the skills they performed. If a lifeguard receives a “Fail” rating in any
skill of the scenario, they receive an overall “Fail” rating. If the overall team response receives a “Fail” rating, each lifeguard on the team receives a “Fail” rating. It is possible for the overall team response
to pass but one of the individual lifeguards to fail.
AN ADULT VICTIM IS SUBMERGED IN THE DEEP END Responder Names and Ratings
Name Name Name Name
Competencies
Water Rescue and Water Rescue: Successfully rescues the victim and brings them to the wall
Extrication
Extrication: Successfully extricates the victim from the water
Communication
Coordination: Clearly and decisively rotates through roles throughout scenario
Primary Assessment Initial Ventilations: Gives two successful ventilations for a victim who is unresponsive as a result
and Chest of a drowning
Compressions
Location: Hands centered on the lower half of the sternum


Location: Correct pad placement; place one pad on the victim’s upper right chest and the other
pad on the left side of the chest
Overall—AED
232
• A “Fail” rating indicates that the lifeguard did not successfully complete one or more of the skills they performed. If a lifeguard receives
a “Fail” rating in any skill of the scenario, they receive an overall “Fail” rating. If the overall team response receives a “Fail” rating, each lifeguard on the team receives a “Fail” rating. It is possible
for the overall team response to pass but one of the individual lifeguards to fail.
A CHILD VICTIM IS SUBMERGED IN THE DEEP END AND APPEARS TO BE UNRESPONSIVE Responder Names and Ratings
Name Name Name Name
Competencies
Water Rescue and Water Rescue: Successfully rescues victim and brings them to the wall
Extrication Extrication: Successfully extricates the victim from the water
Primary Assessment and Initial Ventilations: Gives two successful ventilations for a victim who is unresponsive as a result of a drowning
Chest Compressions Location: Hands centered on the lower half of the sternum
Depth: About 2 inches

Rate: 30 compressions during One-Rescuer CPR, 15 compressions during Two-Rescuer CPR
Location: Correct pad placement; place one pad on the victim’s upper right chest and the other pad on the left
side of the chest
Instructor’s Note: If using a child manikin and pads are touching, place on pad on the chest and one pad on
the back.
Overall—AED
233
• A “Fail” rating indicates that the lifeguard did not successfully complete one or more of the skills they performed. If
a lifeguard receives a “Fail” rating in any skill of the scenario, they receive an overall “Fail” rating. If the overall team response receives a “Fail” rating, each lifeguard on the team receives
a “Fail” rating. It is possible for the overall team response to pass but one of the individual lifeguards to fail.
A CHILD IS SUBMERGED IN DEEP WATER AND APPEARS TO BE UNRESPONSIVE Responder Names and Ratings
Name Name Name Name
Competencies
Water Rescue and Water Rescue: Successfully rescues victim and brings them to the wall
Extrication
Extrication: Successfully extricates the victim from the water
Communication
Coordination: Clearly and decisively rotates through roles throughout scenario
Primary Assessment and Initial Ventilations: Gives two successful ventilations for a victim who is unresponsive as a result of a drowning
Chest Compressions
Location: Hands centered on the lower half of the sternum
Depth: About 2 inches

AED Preparation: Turn on the AED; plug in the connector, if necessary.
Location: Correct pad placement; place one pad on the victim’s upper right chest and the other pad on the
left side of the chest
Instructor’s Note: If using a child manikin and pads are touching, place on pad on the chest and one pad on
the back.
Overall—AED
234
AN ADULT HAS COLLAPSED IN THE LOCKER ROOM Responder Names and Ratings
Competencies
Overall Teamwork and Communication
Primary Assessment Initial Ventilations: Gives two successful ventilations for a victim who is unresponsive N/A N/A N/A N/A
and Chest as a result of a drowning
Compressions Location: Hands centered on the lower half of the sternum

Ventilations & BVM BVM: Connects appropriate sized BVM and resuscitation mask
Location: Correct pad placement; place one pad on the victim’s upper right chest and
the other pad on the left side of the chest
Overall—AED
APPENDIX F
ABOUT THE SCIENCE

ABOUT THE SCIENCE
LESSON AND TOPIC SCIENCE NOTES

PRECOURSE: Swim goggles should only be worn for the prerequisite swim for a variety
SWIM GOGGLES of reasons:
■■ Swim goggles are not part of any standard issue lifeguarding
equipment protocol used in making a land or water rescue.
■■ Swim goggles are designed for preventing water entry and irritation
and not to protect from trauma to the eye. Swim goggles present a
greatly reduced surface area at the point of contact with tissue around
the eye. The potential for serious eye injury is greatly increased by
the swim goggle being contacted by an external object (or another
participant) during the course.
■■ Submerging to a depth of 5 feet or greater has the potential to cause
barotraumas to the eye of an individual wearing swim goggles that
cannot be pressure equalized.
LESSON 2: ■■ During the drowning process, a victim may gasp for air but instead
THE DROWNING inhales water into the airway causing reflexive shutting of the larynx
PROCESS or water aspirated into the lungs. After a period of time with no air
entering the lungs, inadequate oxygenation of body tissues and
eventually cardiac arrest may occur. This can happen in as little as
3 minutes after submerging. Brain damage or death can occur in as
little as 4 to 6 minutes. The sooner the drowning process is stopped
by getting the victim’s airway out of the water, opening the airway
and providing resuscitation (with ventilations or CPR), the better the
chances are for survival without permanent brain damage. Adequate
ventilation and CPR can be performed without the need to remove
water from the lungs.
■■ There are many intervening variables that can affect the outcome of
a drowning victim, such as any underlying medical conditions of the
victim or the time until advanced medical care intervenes. However, in
general, evidence suggests that if the victim is rescued within 1 1/2 to
2 minutes of submerging, giving ventilations may resuscitate the victim.
LESSON 2: Hyperventilation Preceding Underwater Swimming: Voluntary
EFFECTIVE hyperventilation dangerously deregulates brain’s control of breathing
SURVEILLANCE and lowers the blood’s carbon dioxide level. Hyperventilation does not
increase the oxygen level in the blood. After a person takes a series
of rapid and deep breaths and then attempts to swim a long distance,
oxygen is quickly used up. The person will then become unconscious
before the carbon dioxide level raises to the level that triggers the urge to
breath. Drowning then occurs if the person is not rescued.
LESSON 5: ■■ Checking for responsiveness: When checking a person for
PRIMARY responsiveness, sometimes a tapping of the shoulder does not provide
ASSESSMENT enough physical stimuli to elicit a response to pain. Therefore, a
trained responder could employ a “shout-tap-pinch” approach with a
pinch to the muscle between the neck and shoulder in order to provide
a stronger physical stimulus to a sensitive area. It is important that
“shout-tap-pinch” does not delay patient care by adding extra time to
determine a response to verbal or painful stimuli.

LESSON 5: ■■ Recovery Positions: Based on the available evidence, it is important
PRIMARY to turn a person who is responsive and breathing normally but not
ASSESSMENT fully awake onto their side to lower the risk for choking and aspiration.
continued There is little evidence to suggest an optimal recovery position.
However, turning the victim towards the rescuer, rather than away
from the rescuer, allows for more control over the movement and
facilitates monitoring the victim’s airway.
■■ Ventilations for Drowning Victims: Due to the hypoxic nature of
drowning, lifeguards and professional responders should alter the
initial treatment for victims with no breathing and no pulse as a result
of a drowning and provide two initial ventilations during the primary
assessment prior to beginning CPR with chest compressions.
LESSON 5: ■■ Respiratory Arrest: Hyperventilation most commonly occurs

RECOGNIZING when victims are being ventilated in respiratory arrest or when an
AND CARING advanced airway is placed during cardiac arrest. It is critical to avoid
FOR BREATHING hyperventilation of the victim because it leads to increased pressure
EMERGENCIES and a subsequent decrease in cardiac filling and cardiac perfusion
pressures by putting pressure on the vena cava (the main chest vein).
■■ Opioid Overdose: With a growing epidemic of opioid (commonly
heroin and oxycodone) overdoses in the United States, local and
state departments of health have increased access to the medication
naloxone, which can counteract the effects of overdose including
respiratory arrest. Naloxone (also referred to by its trade name
Narcan™) has few side effects and can be administered intranasally
(through the nose). Trained responders should administer the drug
when the patient is in respiratory arrest and an opioid overdose is
suspected. Lifeguards and professional responders should follow
local medical protocols and regulations to determine dosing and
timing of naloxone administration.
LESSON 5 : BVM: Ventilation with a BVM is reserved for when multiple rescuers are
GIVING VENTILATIONS available to treat the victim: One to perform chest compressions and
USING A BVM two others to manage the airway and provide ventilations. While a BVM
may often be used in some situations by a single responder (advanced
medical personnel), the evidence supports the use of a BVM with two
responders: One to maintain an adequate seal and one to squeeze the
bag to deliver the ventilations.
LESSON 5 : Choking: Evidence suggests that it may take more than one technique
AIRWAY to clear the airway, and that back blows, abdominal thrusts and chest
OBSTRUCTION thrusts are all effective.
LESSON 6: There is strong evidence that suggests that when a person is

RECOGNIZING AND experiencing signs and symptoms of a heart attack, outcomes are
CARING FOR A HEART improved when cardiac catheterization is performed within 90 minutes
ATTACK of the onset of signs and symptoms and within 60 minutes of arrival to
the hospital, which is why advanced life support provided by advanced
medical personnel is critical. When cardiac catheterization is not readily
available, the administration of certain medications, including aspirin,
within the first few hours of the onset of signs and symptoms has also
been shown to be of benefit.

LESSON 6: ■■ Chest Compressions: Actual depth may be difficult to judge without
CPR the use of feedback devices, but it is critical to compress the chest AT
LEAST 2 inches for an adult victim. Evidence shows that compression
depths greater than 2.4 inches in the average adult lead to a higher
incidence of non-life threatening injuries and should be avoided.
Compression rates that exceed 120 compressions per minute also
affect the quality of compressions. Evidence suggests that higher
rates of compressions lead to inadequate compression depths.
■■ High Performance CPR: Evidence continues to build that the key to
successful resuscitations is the delivery of high quality CPR, including
uninterrupted chest compressions and ventilations.
■■ CPR Differences–Adult and Child: The majority of pediatric
cardiac arrests are a result of a respiratory cause such as a breathing
problem (asthma/anaphylaxis), an obstructed airway, drowning or an
injury. As such, ventilations and appropriate oxygenation are important
for a successful resuscitation. In these situations, laryngeal spasm
may occur, making passive ventilation during chest compressions
minimal or non-existent.
LESSON 6: ■■ For every 1 minute of delayed defibrillation, the rate of survival drops 7
AED to 10 percent.
■■ AEDs allow for compressions post-analysis while the AED is
charging. Lifeguards and professional rescuers may perform
compressions from the time the shock advised prompt is noted
through the time that the prompt to clear occurs, just prior to
depressing the shock button. Emphasize the need to follow the
manufacturer’s recommendations and their local protocols and
practices.
LESSON 8 : Reassessment of protocols has shown that packaging a victim can
CARING FOR HEAD, be detrimental. They often will lie on spine boards for hours in the
NECK AND SPINAL emergency room, which causes anxiety and can cause physical damage.
INJURIES IN THE Research indicates that the damage has likely already occurred with
WATER the initial injury. The focus for lifeguards should be on safely extricating
the person from the water while maintaining stabilization. Studies have
shown that the application of cervical collars can cause further injury.

APPENDIX G
WRITTEN EXAM ANSWER KEYS AND ANSWER SHEETS

ANSWER SHEET: LIFEGUARDING SKILLS
Name: _____________________________________________________ Date: ________________
Exam A B
1. a b c d 19. a b c d
2. a b c d 20. a b c d
3. a b c d 21. a b c d
4. a b c d 22. a b c d
5. a b c d 23. a b c d
6. a b c d 24. a b c d
7. a b c d 25. a b c d
8. a b c d 26. a b c d
9. a b c d 27. a b c d
10. a b c d 28. a b c d
11. a b c d 29. a b c d
12. a b c d 30. a b c d
13. a b c d 31. a b c d
14. a b c d 32. a b c d
15. a b c d 33. a b c d
16. a b c d 34. a b c d
17. a b c d 35. a b c d
18. a b c d

ANSWER KEY: LIFEGUARDING SKILLS
Name: _____________________________________________________ Date: ________________
Exam A
1. a b c d 19. a b c d
2. a b c d 20. a b c d
3. a b c d 21. a b c d
4. a b c d 22. a b c d
5. a b c d 23. a b c d
6. a b c d 24. a b c d
7. a b c d 25. a b c d
8. a b c d 26. a b c d
9. a b c d 27. a b c d
10. a b c d 28. a b c d
11. a b c d 29. a b c d
12. a b c d 30. a b c d
13. a b c d 31. a b c d
14. a b c d 32. a b c d
15. a b c d 33. a b c d
16. a b c d 34. a b c d
17. a b c d 35. a b c d
18. a b c d

ANSWER KEY: LIFEGUARDING SKILLS
Name: _____________________________________________________ Date: ________________
Exam B
1. a b c d 19. a b c d
2. a b c d 20. a b c d
3. a b c d 21. a b c d
4. a b c d 22. a b c d
5. a b c d 23. a b c d
6. a b c d 24. a b c d
7. a b c d 25. a b c d
8. a b c d 26. a b c d
9. a b c d 27. a b c d
10. a b c d 28. a b c d
11. a b c d 29. a b c d
12. a b c d 30. a b c d
13. a b c d 31. a b c d
14. a b c d 32. a b c d
15. a b c d 33. a b c d
16. a b c d 34. a b c d
17. a b c d 35. a b c d
18. a b c d

ANSWER SHEET: SHALLOW WATER
LIFEGUARDING SKILLS
Name: _____________________________________________________ Date: ________________
Exam A B
1. a b c d 19. a b c d
2. a b c d 20. a b c d
3. a b c d 21. a b c d
4. a b c d 22. a b c d
5. a b c d 23. a b c d
6. a b c d 24. a b c d
7. a b c d 25. a b c d
8. a b c d 26. a b c d
9. a b c d 27. a b c d
10. a b c d 28. a b c d
11. a b c d 29. a b c d
12. a b c d 30. a b c d
13. a b c d 31. a b c d
14. a b c d 32. a b c d
15. a b c d 33. a b c d
16. a b c d 34. a b c d
17. a b c d 35. a b c d
18. a b c d

ANSWER KEY: SHALLOW WATER
LIFEGUARDING SKILLS
Name: _____________________________________________________ Date: ________________
Exam A
1. a b c d 19. a b c d
2. a b c d 20. a b c d
3. a b c d 21. a b c d
4. a b c d 22. a b c d
5. a b c d 23. a b c d
6. a b c d 24. a b c d
7. a b c d 25. a b c d
8. a b c d 26. a b c d
9. a b c d 27. a b c d
10. a b c d 28. a b c d
11. a b c d 29. a b c d
12. a b c d 30. a b c d
13. a b c d 31. a b c d
14. a b c d 32. a b c d
15. a b c d 33. a b c d
16. a b c d 34. a b c d
17. a b c d 35. a b c d
18. a b c d

ANSWER KEY: SHALLOW WATER
LIFEGUARDING SKILLS
Name: _____________________________________________________ Date: ________________
Exam B
1. a b c d 19. a b c d
2. a b c d 20. a b c d
3. a b c d 21. a b c d
4. a b c d 22. a b c d
5. a b c d 23. a b c d
6. a b c d 24. a b c d
7. a b c d 25. a b c d
8. a b c d 26. a b c d
9. a b c d 27. a b c d
10. a b c d 28. a b c d
11. a b c d 29. a b c d
12. a b c d 30. a b c d
13. a b c d 31. a b c d
14. a b c d 32. a b c d
15. a b c d 33. a b c d
16. a b c d 34. a b c d
17. a b c d 35. a b c d
18. a b c d

APPENDIX H
PARTICIPANT’S MANUAL CHAPTER REVIEW
ANSWER KEYS

PARTICIPANT’S MANUAL CHAPTER REVIEW
ANSWER KEYS
Chapter 1 Review
1. What is the primary responsibility of a lifeguard?
A | T
o encourage patrons to participate in C | To schedule and participate in frequent in-
water safety educational programs service trainings
B | T
o prevent drowning and other injuries D | T
o deliver patron safety orientations and
from occurring at their aquatic facility administer swim tests
2. Provide three examples of how lifeguards fulfill their primary responsibility:
Answers should include three of the following:

■■ Monitoring activities in and near the water through patron surveillance.
■■ Preventing injuries by minimizing or eliminating hazardous situations or behaviors.
■■ Enforcing facility rules and regulations and educating patrons about them.
■■ Recognizing and responding quickly and effectively to all emergencies.
■■ Administering first aid and CPR, including using an automated external defibrillator
(AED) and, if trained, administering emergency oxygen when needed.
■■ Working as a team with other lifeguards, facility staff and management.
3. List five examples of secondary responsibilities that should never interfere with
patron surveillance:
Answers should include:

■■ Testing pool water chemistry.
■■ Assisting patrons, such as performing safety orientations, administering swim tests
and fitting for life jackets.
■■ Cleaning or performing maintenance.
■■ Completing records and reports.
■■ Performing opening duties, closing duties, or facility safety checks and inspections.

Chapter 1 Review (continued)
4. List five characteristics of a professional lifeguard:

■■ Knowledgeable and Skilled
■■ Reliable
■■ Mature
■■ Courteous and Consistent
■■ Positive
■■ Professional
■■ Healthy and Fit
5. Lifeguards should:
A | K
eep a cell phone in their hip packs at all C | A
lways be attentive and sit or stand upright
times, in case of emergency. when on surveillance duty.
B | S
tay alert by eating at the lifeguard stand. D | A
ssist patrons with swim testing when on
surveillance duty.
6. A lifeguard is texting while on surveillance duty and fails to recognize a swimmer in

distress. What legal principle could be a problem for this lifeguard?
A | N
egligence C | Refusal of care
B | Abandonment D | Consent

7. List the five steps that a lifeguard should take when obtaining consent from an
injured or ill person before providing first aid or emergency care:
1) State your name.
2) State your level of training.
3) Ask if you may help.
4) Explain that you would like to assess them to find out what you think may be
wrong or what you can do to help.
5) Explain what you plan to do.
8. What is the validity period of an American Red Cross Lifeguarding certification?

How does an American Red Cross certified lifeguard get recertified?
The American Red Cross Lifeguarding/First Aid/CPR/AED Certification is valid for 2 years.
Additional training may be required to meet state and local regulations or facility-specific
policies.
■■ To re-certify, American Red Cross certified Lifeguards with a current certification may
participate in a review course.
■■ Individuals with an expired American Red Cross Lifeguarding/First Aid/CPR/AED
certification may participate in the full Lifeguarding course.
9. Why is it important to attend a pre-season orientation and training?
A | T
o ensure that lifeguards understand their C | T
o ensure lifeguards understand codes,
responsibilities and know how to perform rules and regulations of the facility
their job
D | All of the above
B | T
o ensure that lifeguards get practice with
their facility’s safety and rescue equipment
and emergency action plans

10. What does EAP stand for?
Emergency Action Plan
11. W
hy is it important for lifeguards and other team members to understand and
practice the EAP?
Answers include:
■■ Lifeguards and other staff members must practice the facility’s EAPs together until
everyone knows their responsibilities and can perform them effectively.
■■ Conditions can change throughout the day, so the EAP may need to be adapted to
particular situations (e.g., number of lifeguards on duty, availability of other safety
team members on duty, types of activities occurring, etc.).
12. What
is the best practice for the frequency of in-service training participation at
well-managed aquatic facilities?
A | A
t least 1 hour of in-service training C | A
t least 1 hour of in-service training
each month each day
B | A
t least 4 hours of in-service training D | A
t least 4 hours of in-service training
each year each month
13. What are the benefits of regular, frequent in-service training?
Answer should include:

■■ Helps lifeguards maintain knowledge and skills as a professional rescuer.
■■ Skills degrade quickly and regular practice and feedback keeps skills fresh.
■■ Gives lifeguards a chance to practice with lifeguards at their facility.
■■ Helps lifeguards work with the safety team to efficiently respond in an emergency.

14. List four topics that could be a discussed during in-service training:
Answers should include four of the following:

■■ Address surveillance and recognition issues.
■■ Practice rescue skills.
■■ Understand and practice decision-making protocols.
■■ Review facility rules and regulations.
■■ Review facility protocols including records and reports.
■■ Practice customer service skills.
■■ Physical conditioning for lifeguards.
QU E STION FOR FUTU R E G U I DE D DI SCUSS ION
Being a professional lifeguard is about more than blowing a whistle and

wearing a uniform. A lifeguard must be mentally, physically and emotionally
prepared at all times to do their job. So, how should a lifeguard prepare for
working at an aquatic facility? What personal lifestyle commitments should a
lifeguard make?
Responses should include:
To fulfill the responsibilities of a professional lifeguard, you must be mentally,

physically and emotionally prepared at all times to do your job. As a
professional lifeguard you must:
■■ Have the appropriate knowledge and skills to help prevent and respond to
emergencies.
■■ Be reliable; arrive to work on time and accept assignments willingly.
■■ Be mature, act responsible, take initiative and lead by example.
■■ Show a positive attitude in all job activities.
■■ Look professional and be prepared to respond appropriately to any
situation.
■■ Stay healthy and fit, including regular exercise, good nutrition and a
balanced diet, proper hydration, adequate rest and protection from sun
exposure.

Chapter 2 Review
1. What items are considered to be personal protective equipment for a lifeguard?

■■ Gloves
■■ Resuscitation Masks
■■ Gowns
■■ Shields
■■ Protective Eyewear
2. What equipment should be worn or carried by a lifeguard at all times while on

duty? List at least two and include the reason(s) why this equipment should be worn
or carried.

■■ A Rescue Tube should be worn at all times when performing patron surveillance.
Rescue tubes are capable of keeping multiple victims afloat and they are the primary
piece of equipment used to perform a water rescue.
■■ Hip-Packs containing gloves and resuscitation mask(s) should be worn by
lifeguards at all times, even when not on surveillance duty, so that equipment is
instantly available in an emergency.
■■ Resuscitation Mask(s) allow lifeguards to breathe air into a victim without making
mouth-to-mouth contact. Resuscitation mask(s) should be carried in the Lifeguard’s
hip pack at all times, even when not on surveillance duty, so that it is available
instantly in an emergency.
■■ A Whistle is a signaling device for lifeguards used to activate the facility’s EAP and
to get attention of other members of the safety team as well as patrons for policy
enforcement. Whistles should be loud, made of material that will not rust and have
breakaway lanyards. Lifeguards should wear whistles at all times.
■■ Disposable Gloves are used to protect lifeguards that may be exposed to blood
or other potentially infectious material (OPIM). Gloves should be carried in the
Lifeguard’s hip pack at all times, even when not on surveillance duty, so that they are
available instantly in an emergency.

3. What safety equipment/items should be easily accessible for a lifeguard while on
duty? List at least two and describe how/when each item is used.

■■ Backboards are a standard piece of equipment used at aquatic facilities to
remove victims from the water when they are unable to exit the water on their own
or they have a possible head, neck or spinal injury.
■■ Automated External Defibrillators (AEDs) are used to analyze the hearts
rhythm and deliver an electrical shock (when needed) to help re-established an
effective heart rhythm. AEDs are used in conjunction with CPR.
■■ First aid kits include supplies used to treat common injuries at aquatic facilities
including bleeding and wounds and help stabilize injuries to muscles, bones and
joints.
■■ Bag-Valve-Mask (BVM) resuscitators are used to ventilate a victim in respiratory
arrest or when performing CPR with more than one rescuer.
■■ Personal Protective Equipment (PPE) is used to prevent lifeguards from
coming into direct contact with a victim’s body fluids. PPE includes gloves,
resuscitation masks, gowns, masks, shields and protective eyewear.
■■ Rescue boards (for waterfront facilities) are used as standard equipment at
waterfront facilities and are designed to accommodate a lifeguard plus one or more
victims. Rescue boards may be used during rescues to quickly paddle out long
distances or as a patrolling device for lifeguards.

4. As a lifeguard, you are responsible for:
A | E
nsuring that your facility is in compliance C | C
onsistently enforcing your facility’s rules
with local, state and federal regulations. and regulations.
B | C
reating and reviewing your facility’s D | C
reating rules, regulations and emergency
policies and procedures manual. action plans.
5. List five common rules and regulations often posted at an aquatic facility.
Answers should include five of the following:

■■ Swim only when a lifeguard is on duty.
■■ Swim diapers are required for small children or people with incontinence.
■■ No swimming with open or infected wounds.
■■ Obey lifeguard instructions at all times.
■■ No running, pushing or rough play.
■■ No hyperventilating before swimming underwater or breath-holding contests.
■■ No sitting or playing near or with drains or suction fittings.
■■ Dive only in designated areas.
■■ No glass containers in the pool area and locker rooms.
■■ No alcoholic beverages or drug use allowed.
6. Explain what it means to be “equipped and rescue-ready.”
Equipped and rescue-ready means that you are wearing or carrying the appropriate rescue
equipment for your facility and ready to enter the water to perform a rescue.

7. Identify at least two reasons why each lifeguard in the images below is not
equipped and rescue-ready and indicate what can be done to improve each
situation.
■■ Lifeguard does not have a rescue tube.

■■ Lifeguard has no sun protection (no hat, sunglasses or
umbrella).
■■ Lifeguard is sitting with crossed legs.

■■ Lifeguard is wearing sneakers.
■■ Lifeguard in the chair is not wearing a hip pack.

■■ Lifeguard on the ground is not looking at the pool.

Effective surveillance includes several elements. What are these elements

and why are they instrumental to keeping patrons safe?
Elements of effective surveillance include:

■■ Recognition of dangerous behaviors
■■ Victim recognition
■■ Effective recognition
■■ Zone of surveillance responsibility
■■ Lifeguard stations
With effective surveillance, lifeguards can recognize behaviors or situations

that might lead to life-threatening emergencies (such as drownings or injuries
to the head, neck or spine) and act quickly to modify the behavior or control
the situation.

ADDITIONAL REVIEW QUESTIONS FOR WATERFRONT LIFEGUARDS:
1. Which list of typical safety checklist items, along with others, applies to a lakefront
swimming area?
A | W
ater chemistry, circulation system, drain C | E
mergency shut-offs, tubes,
covers, starting blocks communication between ride dispatch and
landing
B | B
ottom conditions, pier attachments,
buoys, safety lines D | W
ave height, tide charts, rip currents,
beach flags
2. Which list of typical rules, along with others, applies to a lakefront swimming area?
A | N
o diving in shallow water, no running C | No swimming under piers, no fishing near
on pool deck, shower before entering swimming area
the water
D | S
hower before entering, limit time in high
B | R
ide slides feet-first, stay on temperature water, remove swim caps
tubes, observe minimum height or
weight requirements

ADDITIONAL REVIEW QUESTIONS FOR WATERPARK & AQUATIC
ATTRACTION LIFEGUARDS
1. In a waterpark setting, what additional items might be included in a safety checklist?

■■ Shoreline is clean and free of sharp objects
■■ Bottom conditions are free from hazards
■■ Water conditions are safe for swimming
■■ Piers are anchored, stable, free from trip or injury hazards
■■ Lifeguard stands and surrounding areas are clear of objects
2. Why should waterparks have signs posted at every attraction stating the water depth?
Answer:
■■ To prevent patrons from finding themselves in what is deeper or shallower water
than expected.
3. What rules are typically covered for waterpark attractions?

■■ The minimum or maximum number of people allowed on an attraction or a tube at a
time.
■■ The maximum height or age requirements in areas designated for small children.
■■ The minimum height or weight requirements for patrons using an attraction.
■■ Life jacket requirements.
■■ Health restrictions.
■■ Proper riding position for a slide or ride vehicle.
4. What are some factors that make lifeguarding waterparks different than a typical pool? © 2011, 2017, 2019 The American National Red Cross. All rights reserved.

■■ Various attractions (winding rivers, water slides, wave pools, splash castles, etc.)
■■ Ride vehicles
■■ Currents on attractions
■■ Potentially larger crowds
■■ Different rules and EAPs

Chapter 3 Review
1. In general, there are three types of swimmers in distress or drowning victims. List
each type with three observable characteristics for each.

1) Distressed Swimmer
■■ May be able to keep their face out of the water
■■ May be able to call or wave for help
■■ Horizontal, vertical or diagonal, depending on what they use to support themselves
■■ Floating, sculling or treading water
2) Drowning Victim—Active
■■ Not able to call out for help because their efforts are focused on getting a breath
■■ Works to keep the face above water in an effort to breathe
■■ May be in a horizontal face-down position during the struggle because they are unable
to lift their face out of the water (for example: a toddler)
■■ Has extended the arms to the side or front, pressing down for support
■■ Is positioned vertically in the water with an ineffective kick; a young child may tip into a
horizontal face down position
■■ Might continue to struggle underwater once submerged
■■ Eventually will lose consciousness and stop moving
3) Drowning Victim—Passive
■■ Might float face-down at or near the surface or might sink to the bottom
■■ May be limp or have slight convulsive-type movements
■■ Has no defined arm or leg action, no locomotion and no breathing
■■ May appear to be floating, if at the surface of the water
■■ May be face-down, on one side or face-up, if at the bottom
2. Match each station type with its general use: © 2011, 2017, 2019 The American National Red Cross. All rights reserved.
D Roving Stations A. Puts you close to the patrons to easily make assists
C Elevated Stations B. Used in waterfront facilities to patrol the outer edge of

a swimming area
A Ground-Level Stations C. Ideal for a single guard facility
B Floating Station D. Good to use with a crowded zone

3. A lifeguard on duty should be able to recognize and reach a drowning victim within:
30 seconds.
4. The size of a zone should allow for a lifeguard to recognize an emergency, reach
the victim, extricate and provide ventilations within ______. Explain why.
1½ to 2 minutes
In general, if you can provide ventilations within 1½ to 2 minutes, you might be able to
resuscitate the victim.
5. What is the difference between total and zone coverage?
Total coverage:
Total coverage means that you are the only lifeguard conducting patron surveillance while
on duty. Some facilities, such as a small pool, assign their lifeguards total coverage. When
only one lifeguard is conducting patron surveillance, that lifeguard has to scan the entire
area, control the activities of patrons in and out of the water and recognize and respond to
emergencies.
Zone coverage:
Zone coverage means that the swimming area is divided into separate zones, with one
zone for each lifeguard station. Zones can be designated by markers, such as ladders, lane
lines, lifelines, buoys or the shape of the pool.
6. Lifeguards should be actively ___________ their zones.
A | Changing C | Creating
B | Watching D | Searching
Why? Lifeguards should search their assigned zones for behaviors that indicate a patron is
in need of immediate assistance. Lifeguards should be searching for behaviors of a
drowning victim or swimmer in distress.

7. You are guarding a lap swim with only two patrons. All of the following will help you
deal with the monotony EXCEPT for which?
A | S
tay fully engaged and do not let C | Swing your whistle lanyard.
attention drift.
D | Sit upright and slightly forward.
B | C
hange body position and posture
periodically.
8. It is very hot in your facility and you are starting to doze on the stand. All of the
following can help you stay alert EXECPT for which?
A | Stay in a cooler area during breaks. C | Rotate more frequently.
B | S
tay hydrated while drinking plenty D | Jump in the pool while on surveillance
of water. duty to cool off.
9. You are distracted by the glare of the lights on the water and the water movements
are making it hard to see all areas of your zone. Circle all acceptable options.
A | Wear polarized sunglasses. D | B
e aware of the normal appearance
of the bottom of the pool; know the
B | Adjust your body position; stand up to look appearance of drains, colored tiles
around and through the glare spots. or painted depth markings.
C | R
eposition the lifeguard station with the E | D
o not change your position as the
permission of your supervisor. lifeguard stations are placed to be
aesthetically pleasing.
10. W
hy is it important for lifeguard managers to conduct drills to test zones?
Lifeguard zones should be set up for success—the lifeguard must be able to clearly see all
parts of the zone as well as be able to quickly respond in an emergency.

11. F
ill in the blank:
Voluntary hyperventilation
__________________________________________ , which can be described as rapid, deep
breathing, is a dangerous technique used by some swimmers to try to swim long distances
underwater or to hold their breath for an extended period while submerged in one place.
If you see these dangerous activities, you must intervene.
12. RID stands for

R: Recognition
I: Intrusion
D: Distraction
13. During rotation, both lifeguards must ensure there is no lapse in patron
surveillance, even for a brief moment. To ensure this, what should each
lifeguard do?
The incoming lifeguard should:

Search the zone and activity level of the zone that you will be guarding. Begin searching
your zone as you are walking toward your station, checking all areas of the water from the
bottom to the surface.
The outgoing lifeguard should:

Inform the incoming lifeguard of any situations that need special attention. The exchange
of information should be brief, and patron surveillance must be maintained throughout
the entire rotation. Once in position, with the rescue tube strapped in place, the incoming
lifeguard should make any adjustments needed, such as removing shoes or adjusting an
umbrella before confirming to you that they own the zone. Confirm and signal that the zone
is clear and transfer responsibility for the zone. You should continue scanning as you are
walking toward the next station.

What are some common injuries at a pool? How can a lifeguard treat and
prevent them?

■■ Fractures
■■ Dislocations
■■ Abrasions (scrapes)
■■ Superficial burns (sunburns)
■■ Muscle cramps
■■ Heat exhaustion
■■ Dehydration
■■ Sprains and strains
Lifeguards can help prevent these injuries by:

■■ Understanding how most injuries occur
■■ Increasing awareness of risks and hazards
■■ Helping patrons avoid risky behavior, including educating patrons about
the consequences of risky behavior
■■ Developing a safety-conscious attitude
Lifeguards can treat these injuries by providing appropriate emergency care

according to their level of training.

1. Which scanning challenge often occurs at waterfronts but should not exist
at pools?
A | Distractions C | Murky water
B | Heavy patron loads D | High air temperature
2. Who normally provides training for watercraft used at some waterfront facilities?
A | The lifeguard’s training agency C | Facility management
B | The lifeguard figures it out D | T

he U.S. Coast Guard

ADDITIONAL REVIEW QUESTIONS FOR WATERPARK LIFEGUARDS:
1. In a waterpark setting, which type of lifeguard stations might you encounter
in a rotation?

■■ Elevated stations
■■ Ground-Level stations
■■ Roving stations
■■ Dispatch stations
■■ Landing zone stations
2. What are lifeguards guarding at dispatch stations responsible for?
Assessing each potential rider to ensure that they meet all of the requirements for riding
the attraction. Verifying that each rider wishing to ride the attraction is capable of holding
themselves in the proper riding position.
3. What are some characteristics unique to waterpark features that may make it more
difficult to see a drowning victim?

■■ Current, moving water or waves of an attraction
■■ Unexpected changes in depth
■■ Floating play structures
■■ Tubes or other ride vehicles from which patrons may fall
4. What are some scanning challenges that you may encounter when guarding a play
structure? What tactics can you use to counteract them?

■■ Overcrowding. Be aware of your facility guidelines regarding the number of patrons
allowed on the play structure and be prepared to restrict that number or summon
additional help.
■■ Features such as towers, sprayers or climbing structures; be sure to move around your
zone or change body position so you are able to see all areas of your assigned zone.

Chapter 4 Review
1. List the three major strategies a lifeguard can use to help prevent injuries at an
aquatic facility.

■■ Communicating with patrons
■■ Informing and educating patrons
■■ Enforcing rules
2. List three things that can help determine if a life jacket is appropriate for use.

■■ The life jacket is U.S. Coast Guard Approved.
■■ The life jacket is in good condition; no rips, tears, holes or shrinkage of the buoyant
materials.
■■ The life jacket is appropriately sized for the patron; life jackets are sized by weight.
Check the U.S. Coast Guard label to be sure the fit is matched to the weight range of
the patron.
■■ The life jacket is properly worn. A properly fitted life jacket should feel snug, keep the
person’s chin above the water and allow the person to breathe easily. The life jacket
should not ride up on the patron’s body in the water. Completely secure any straps,
buckles or ties associated with the life jacket.
■■ The patron(s) are properly using the life jacket. Correct any improper wearing or use
of life jackets. Do not allow patrons to wear multiple life jackets or stack multiple life
jackets on top of each other to be used as floats.

3. Many facilities have unique challenges that demand different kinds of surveillance.
For each situation listed below, list two guidelines you should keep in mind when
providing surveillance for patrons.
Guarding areas for young children:

Answers include:
■■ Older children might be too large for some structures, or their play might be too
rough for young children.
■■ Toddlers who are still learning to walk may fall easily. If they fall down in water, they
usually cannot lift themselves to an upright position, even if the water is ankle or
knee deep.
■■ Children often get lost. Remind adults to supervise their children at all times.
■■ You must watch out for young children using the pool as a toilet. The facility should
have procedures for preventing and addressing the situation, including handling
fecal incidents, which follow local health department guidelines.
■■ Children usually do not think about overexposure to the sun or hypothermia. If a
child is becoming sunburned or overly cold, immediately inform the child’s parent or
guardian.
Play structures:
■■ Do not let a play structure become overcrowded. Be prepared to restrict the
number of patrons using it at one time.
■■ Do not allow patrons to swim underneath structures.
■■ Watch that patrons return to the surface after dropping into the water from a
floating feature. Swimmers can be surprised by the fall or become disoriented,
especially if they do not realize they will be dropping into deep water.
■■ Pay close attention to children playing in and around sprays, fountains and
interactive water-play structures. These attractions usually are in shallow water.
Excited children may run and fall. A very young child who falls might not be able to
get back up or may strike their head.
■■ Pay close attention to patrons in moving water. Moving water can surprise people.
They might lose their balance and be unable to stand up again.
■■ Watch for overcrowding and horseplay on floating structures. These structures are
tethered to the bottom of the pool; some allow patrons to walk from one floating
structure to another while holding onto an overhead rope.
■■ Keep play safe and orderly.
■■ Patrons may climb onto floating toys and jump back into the water. They may not
notice what is around them and jump onto other swimmers or into water that is over
their heads.
■■ Patrons may throw balls and other toys and hit unsuspecting swimmers, resulting in
injury.

4. Identify three strategies for ensuring safe group visits.
Answers include:
■■ Booking procedure. Before the visit, group leaders should provide the aquatic
facility with information about how many group members and supervisors will be
visiting, including swimmer characteristics such as percentage of swimmers and non-
swimmers.
■■ Safety orientation. Conducted when the group first arrives at the facility.
■■ Classification of swimming abilities/Swim testing. Swim tests are administered
to determine if a visitor has the minimum level of swimming ability required to
participate safely in activities, such as swimming in water over their head or riding on
certain slides.
■■ Designation of swimming areas. Swimming areas should be clearly marked and
defined according to swimmers’ abilities and intended use.
■■ Identification of group leaders or adult chaperones. Your facility should use an
identification system so that lifeguards and other facility staff can easily locate group
leaders or adult chaperones.
■■ Buddy systems and buddy checks. Provide an additional layer of protection,
specifically with larger groups including camps.
5. W
hy is it important to educate your patrons about safety in, on and around the water?

■■ Patrons need to know about the risks that can cause injury.
■■ Patron education and instruction on how to use equipment and follow rules can prevent
behaviors that lead to injury.
■■ Patrons may be unfamiliar with facility features, or be so excited that they do not read
signs or pay attention to rules.
6. You are in the lifeguard office taking a break from surveillance duty and a camp
counselor requests a swim test for a new camper. You use the Red Cross water com-
petency sequence to conduct a swim test. Describe these steps in order:
1) Enter the water and completely submerge.
2) Recover to the surface and remain there for at least 1 minute (floating or treading).
3) Rotate 360 degrees and orient to the exit.
4) Level off and propel yourself on the front or the back through the water for at least 25 yards.
5) Exit from the water.

1. At waterfront facilities using swim tests for group visits, areas for
nonswimmers should:
A | Begin in shallow water and grade C | E
xtend slightly into deep water for practice.
seamlessly into deep water appropriate
for swimmers. D | Include designated deep water areas
for diving.
B | B
e separated from the swimmer area with
a continuous barrier, such as a pier or
buoyed lifeline.

ATTRACTION LIFEGUARDS:
1. Many facilities have unique challenges that require different guarding strategies.
For each situation listed below, list two guidelines you should keep in mind when
guarding patrons at the following attractions.
Aquatic attractions:
Answers should include two of the following:
■■ Watch patrons as they enter and exit an attraction. Dispatch patrons safely on a ride at
set intervals. Dispatching is the method of informing patrons when it is safe for them to
proceed on a ride.
■■ Carefully watch both the water below and the activities overhead.
■■ Keep patrons in view as long as possible. Keeping patrons in view can be a problem
on some attractions. Structures, such as caves, enclosed tubes, bridges and buildings
might prevent you from seeing patrons at all times. When a patron goes out of sight,
watch to make sure that they emerge safely on the other side.
■■ Ensure that patrons who submerge return to the surface. The excitement may cause
weak swimmers or non-swimmers to overestimate their abilities or underestimate the
water’s depth.
■■ Be aware of special risks. Structures designed to have patrons sit or climb on them, or
swim over or under them, pose hazards. Supervise patrons carefully. Someone who falls
off of a mat, raft or tube might be injured or pose a hazard to another patron.
Wave pools:
■■ Ensure that patrons enter only in the shallow end.
■■ When the waves are on, stand up to get a better view of patrons.
■■ Watch for swimmers who get knocked over by the waves or carried into deeper water
by the undercurrent. Inexperienced swimmers may go to where the waves break
because of the excitement.
■■ Do not let patrons dive into the waves or dive through inner tubes.
■■ Keep the areas around ladders and railings clear so that patrons can exit from the pool
quickly.
■■ Keep other swimmers out of the pool during special activities like surfing. The
surfboards or boogie boards in the wave pool can present a hazard to others.
■■ Before performing an emergency rescue, turn the waves off using the emergency
stop (E-stop) button at the lifeguard chair.
■■ Rotate positions only when the waves are off.

2. What additional challenges might you face when enforcing rules in a waterpark?

■■ Background music
■■ Loud patrons
■■ Large crowds
■■ Movement/current of a winding river
3. What are some responsibilities of a lifeguard assigned the landing zone of a slide?

■■ Helping riders exit the ride.
■■ Ensuring that the landing zone is clear.
■■ Communicating with the dispatching lifeguard.
■■ Moving ride vehicles onto a conveyor or stacking them to be used by other patrons.
4. What are some examples of rules or policies that might be found in a

waterpark setting?

■■ Height or weight requirements for attractions
■■ Specific rules for ride vehicles
■■ Proper ride positions
■■ No forming chains on a winding river

Chapter 5 Review
1. Why should an EAP be facility specific?
So that all staff know their responsibilities as it relates to that facility. Factors such as the
facility’s layout, number of staff on duty at a time, location of backup lifeguards and other
safety team members, equipment used and typical response times of the local emergency
medical services (EMS) system are included in the plan and depend on the facility.
2. Provide three examples of situation-based EAPs.

■■ Water emergency—Drowning victim—active
■■ Water emergency—Drowning victim—passive
■■ Water emergency—Spinal injury victim
■■ Water emergency—Missing person
■■ Land emergency—Injury or illness
■■ Evacuations
■■ Sheltering in place
■■ Severe weather
■■ Chemical spills or leaks
■■ Power failures
■■ Violence
■■ Thefts in progress
3. Place the following EAP actions in order for a situation where the victim is
responsive and does not require additional care:
2 Rescue
4 Equipment check/corrective action
1 Signal
5 Return to duty
3 Report, advise, release

4. Describe the actions of the additional safety team members listed below during a
rescue where the victim is unresponsive and requires additional emergency care.
Other lifeguards:
1) Assist with the rescue by providing emergency care.
2) Provide backup zone coverage or clear the area.
Additional safety team members:

(Front desk staff, maintenance staff or others as designated by the EAP)
1) Summon EMS Personnel.
2) Bring additional equipment if necessary.
3) Clear the area or facility.
4) Control the crowd.
5) Meet EMS personnel.
6) Assist the lifeguards by providing emergency care (if trained and outlined in the EAP).
5. When completing a report, you should:

A | Include all details about the incident, C | C
ollect all factual information about what
including your opinion about how the was seen, what was heard and what ac-
incident happened. tions were taken.
B | A
llow witnesses to discuss their thoughts D | N
ot allow the victim to leave until you have
about the incident before compiling their completed the report and your
statement onto one report. supervisor has signed it.

6. Who should deal with questions from the media after an incident? Select all
that apply.
A | The lifeguard who performed the rescue D | The company spokesperson
B | T
he front desk attendant who called 9-1-1 E | EMS personnel
C | The facility manager
Why? Only management or a designated spokesperson should talk to the media or others
about an incident. Sharing details about an incident could violate a victim’s privacy,
which is protected by confidentiality laws. Failure to follow facility procedures for dealing
with the media could lead to legal action.
7. Why might a supervisor choose NOT to re-open a facility that was closed during an
emergency? Provide one example.
Answers may include:

■■ Not enough lifeguards ready to return to surveillance duty.
■■ Missing or damaged equipment.
■■ Spills involving blood or other potentially infectious materials have to be cleaned.
■■ Power failure.
8. Members of the safety team, including non-lifeguard personnel, should be:

A | T
rained and certified in first aid and C | T
rained in CPR if they are interested in
CPR/AED at the same level of the receiving training.
lifeguard team (for professionals).
D | T
rained to follow the other EAP duties
B | T
rained in first aid and CPR for that do not involve providing care.
non-professionals.

9. After an emergency has been resolved, there are still three important tasks to
complete. Explain each task.
Report:
Fill out the appropriate incident report form as quickly as possible after providing care.
Advise:
Give the victim safety instructions to prevent a similar incident from recurring or
recommend that the person follow up with a health care provider.
Release:
In some cases, you will release the person under their own care or to a parent, guardian,
camp counselor, group leader, instructor or other staff member.
10. Y
ou must be prepared to respond to emergencies that are outside of the
immediate aquatic environment and not part of your zone of responsibility.
Describe three areas where these emergencies could occur.

■■ Locker rooms
■■ Concession areas
■■ Entrance and lobby areas
■■ Mechanical rooms
■■ Playgrounds and play areas
■■ Parking lots

ADDITIONAL R EVI EW QU E STION S FOR WATE R FRONT LI FEG UAR DS:
1. An EAP for a missing person includes quickly checking if the person is in the water.
Checking for a submerged victim is most difficult for which area?
A | S
pa with the bottom obscured by C | U
nderneath play structures in a swimming
water jets pool
B | L
ap swimming area in a pool with D | U
nderneath play structures at a waterfront
lane lines with murky water

1. What additional steps might be included in the EAP for a wave pool, a winding
river and the landing zone of a speed slide?

■■ Pressing the emergency stop (E-stop) button to turn off the waves in a wave pool.
■■ Shutting off the flow of water in a slide or winding river.
■■ Stopping the dispatch of riders at a speed slide.
2. What additional actions must be taken after signaling an emergency in the

following attractions?
Wave pool:
Pushing the emergency stop (E-stop) button is required to stop the waves before
attempting a rescue.
Slides:
The signal must alert the lifeguard stationed at the top to stop dispatching more riders.
3. What signals would you most likely use to activate the EAP in a waterpark setting?

■■ Whistle blast.
■■ Call box (pushing a button or dropping a phone).
■■ Pressing an E-stop button.

Chapter 6 Review
1. List the general procedures, in order, for situations involving a water rescue.
1) Activate the emergency action plan (EAP).
2) Enter the water, if necessary.
3) Perform an appropriate rescue.
4) Move the victim to a safe exit point.
5) Remove the victim from the water.
6) Provide emergency care as needed.
7) Report, advise and release.
2. What are some factors that should be considered when deciding how to enter the
water? Select all that apply.
A | Location of the victim E | Water temperature
B | L
ocation of other swimmers F | Your location
C | Size of the victim G | Facility design/set-up
D | Condition of the victim H | Type of equipment used
3. In addition to the correct answer(s) above, what additional factors should be con-
sidered when deciding how to enter the water and why?

■■ Water depth and/or design of the lifeguard station; different entries are
recommended for different water depths and various lifeguard stations/positions:
• The slide-in entry is safest in most conditions, including shallow water.
• The stride jump should only be used if the water is at least 5-feet deep and you are no
more than 3 feet above water.
• The compact jump should only be used when the water is at least 5-feet deep and can
be used from the deck or from a height, such as on a lifeguard stand.
• The run-and-swim entry should be used to enter the water from a zero-depth entry,
gradual slope facility.
■■ Obstacles in the water (including people and lane lines); it may not be safe to enter the
water using a compact jump or stride jump if your zone is crowded or contains obstacles.
• The slide in-entry is useful in a crowded pool or in an area with obstacles.

4. Identify the appropriate entry for each scenario listed below:
SCENARIO ENTRY
You are seated on an elevated lifeguard stand in the deep Compact Jump
end during recreational swim and spot a passive-drowning
victim. The area surrounding your station is clear of patrons
and objects.
You are searching your zone from an elevated station when Slide-In Entry
you spot a patron who appears to have a head injury as a
result of diving in shallow water.
You spot an active drowning victim while searching your Slide-In Entry
zone from a ground-level station located in the middle of the
pool where the water is 4’ deep.
You are searching your new zone as you walk toward the Stride Jump
elevated lifeguard stand in the deep end before a rotation
and you spot an active drowning victim.
You have just rotated to a roving station during open swim Run-and-Swim
at a crowded waterfront and spot a swimmer in distress.
5. What are the two most common assists and when should each be used?
1) Simple assist. A simple assist can be used in shallow water and may be merely
helping a person to stand. The simple assist also may be used to rescue a victim who
is submerged in shallow water and is within reach.
2) Reaching assist from the deck. To assist a distressed swimmer who is close to the
side of the pool or a pier, use a reaching assist from the deck by extending a rescue
tube within the victim’s grasp.

Select the appropriate rescue or extrication method for the scenarios below:
6. You are approaching a victim who is vertical in the water, near the surface in 4 feet
of water. The victim is facing you and appears to be unconscious.
A | Active Victim Front Rescue C | P
assive Victim in Extreme Shallow
Water–Face-Up
B | Passive Victim Front Rescue
D | Submerged Victim in Shallow Water
7. You are approaching a child who is facing away from you and struggling to keep
their head above water.
A | Active Victim Rear Rescue C | Passive Victim Rear Rescue
B | Active Victim Front Rescue D | Passive Victim Front Rescue
8. You are approaching a victim from behind who appears to be unconscious.

A | P
assive Victim Front Rescue followed by C | P
assive Victim Front Rescue followed by
Extrication Using a Backboard a Walking Assist
B | P
assive Victim Rear Rescue followed by a D | Passive Victim Rear Rescue followed by
Two-Person Extrication Extrication Using a Backboard
9. A victim in the water is not breathing.

A | Always
remove a victim who is not C | G
ive ventilations and CPR in the water for
breathing from the water as soon as 1 minute, 30 seconds and then remove
possible to provide care. However, if them from the water.
doing so will delay care, then perform in-
water ventilations until you can remove the D | W
ait for additional assistance to remove
victim. the victim from the water.
B | G
ive ventilations in the water, then remove
the victim from the water.

10. What are four core objectives in any rescue situation?
Answers should include the following:

■■ Ensure the safety of the victim, yourself and others in the vicinity. This includes the
entry, approach, rescue, removal and care provided.
■■ Use a rescue technique that is appropriate and effective for the situation.
■■ Provide an appropriate assessment, always treating life-threatening conditions first.
■■ Handle the rescue with a sense of urgency.

ATTRACTION LIFEGUARDS
1. What should you consider when deciding what entry to use at a wave pool?

■■ The number of patrons.
■■ The height of your station.
■■ The depth of the water at your station.
■■ The mechanism of injury of the victim.
■■ The location of your station.
2. What attraction features might impact the removal of the victim from the water?

■■ Type of exit from attraction (stairs, high edges, ladder, zero entry, etc.).
■■ Ride vehicles.
■■ Water movement (current or waves).
■■ Shape of the attraction (e.g., walls of a speed slide).

Chapter 7 Review
1. Touching soiled dressings that are contaminated with potentially infectious
material is an example of:
A | Indirect contact C | D
roplet contact
B | Direct contact D | Vector-borne contact
2. Examples of work practice controls include:

A | D
isposing of sharp items in puncture C | C
leaning/disinfecting all equipment and
resistant, leak-proof, labeled container work surfaces possibly soiled by blood
or other potentially infectious material
B | R
emoval and proper disposal of soiled
protective clothing as soon as possible D | All of the above
3. The OSHA recommended solution to use for disinfecting contaminated or soiled

equipment and surfaces is:
A | 4 cups of bleach per gallon of water C | 1
/4 cup of antibacterial soap per gallon
of water
B | 1 cup of ammonia per gallon of water D | 1 part bleach per 9 parts water
4. Place the following general procedures for injury or sudden illness on land in order:
2 Perform a primary assessment.
5 Provide care for the conditions found.
3 Summon EMS, if needed and not already done.
1 Size up the scene.
6 Report, advise and release.
4 Perform a secondary assessment.

5. Describe six actions you should take or determinations that you should make
while performing a scene size-up:
1) Use your senses to check for hazards that could present a danger to you or the victim.
2) Use appropriate PPE.
3) Determine the number of injured or ill victims.
4) Determine what caused the nature of the illness; look for clues to what may have caused
the emergency and how the victim became injured or ill.
5) Form an initial impression that may indicate a life-threatening emergency.
6) Determine what additional resources may be needed.
6. Provide a situation and specific example of when you should move a victim who is
on land.

■■ You are faced with immediate danger. Examples include but are not limited to:
• Fire or immediate risk of fire
• Severe weather
• Chemical spills
■■ You need to get to other victims who have more serious injuries or illnesses such as an
unresponsive victim who is not breathing or has no pulse.
■■ It is necessary to provide appropriate care. Examples include but are not limited to:
• Moving a victim to the top or bottom of a flight of stairs to perform CPR.

7. If you are alone when responding to someone who is ill, you must decide whether
to Call First or Care First.
When should you Call First?

Call 9-1-1 or the designated emergency number first, before providing care for:
1. Any adult or child about 12 years of age or older who is unresponsive.
2. A child or an infant who you witnessed suddenly collapse.
3. An unresponsive child or infant known to have heart problems.
When should you Care First?

Care First (provide 2 minutes of care, then call 9-1-1 or the designated emergency
number) for:
1. An unresponsive child (younger than about age 12) who you did not see collapse.
2. Any victim suspected of drowning.
8. How do you tell the difference between an adult, a child and an infant?
Adult: Puberty and older.
Child: 1-year to puberty (development of breasts in girls and underarm hair in boys).
Infant: Up to 1 year.
9. During the primary assessment, you find the victim is not breathing and has no
pulse. When would you give 2 ventilations before starting CPR?
For a drowning victim pulled from the water.

Chapter 8 Review
1. Fill in the blanks: Lack of oxygen can eventually stop the heart (cardiac arrest)
and prevent blood from reaching the brain and other vital organs in as little as ____3
minutes after submerging. Brain cell damage or death begins to occur within ____ 4
6 minutes.
to____
2. Describe the two types of respiratory emergencies:
Respiratory distress: A condition in which breathing becomes difficult.
Respiratory arrest: A condition in which breathing stops.
3. List five possible causes of respiratory distress.

■■ A partially obstructed airway
■■ Illness
■■ Chronic conditions, such as asthma and emphysema
■■ Congestive heart failure
■■ Electrocution, including lightning strikes
■■ Heart attack
■■ Injury to the head, chest, lungs or abdomen
■■ Allergic reactions
■■ Drug overdose
■■ Poisoning
■■ Emotional distress
■■ Anaphylactic shock
4. When caring for a person in respiratory distress:

A | A
sk the victim to stand and lean back to C | D
o not allow the victim to take their
make breathing easier. prescribed medication.
B | Determine the exact cause of respiratory D | M

aintain an open airway and summon
distress before providing initial care. EMS personnel.

5. List five possible causes of respiratory arrest.

■■ Drowning
■■ Obstructed airway (choking)
■■ Injury to the head, chest, lungs or abdomen
■■ Illness, such as pneumonia
■■ Respiratory conditions, such as emphysema or asthma
■■ Congestive heart failure
■■ Heart attack
■■ Coronary heart disease (such as angina)
■■ Allergic reactions (food or insect stings)
■■ Electrocution, including lightning strikes
■■ Shock
■■ Poisoning
■■ Drug overdose
■■ Emotional distress
6. When checking to see if someone is breathing (circle all that apply):

A | L
ook to see if the victim’s chest clearly D | L
ook away from the victim’s chest.
rises and falls.
E | Keep the victim’s mouth closed.
B | C
heck for breathing before checking
for a pulse. F | L
isten and feel for air against the side
of your face.
C | C
heck for breathing and a pulse
simultaneously.
12 and ____
7. Fill in the blanks. The normal breathing rate for an adult is between ____ 20
breaths per minute.
8. What is a lifeguard’s objective when caring for a drowning victim who is

not breathing?
To get the victim’s mouth and nose out of the water, open the airway and give ventilations
as quickly as possible.

9. When giving ventilations to an adult who is not breathing but has a definitive pulse,
you should give ventilations:
A | 2
every 5 to 6 seconds C | 1
every 3 seconds
B | 2
every 3 seconds D | 1
every 5 to 6 seconds
10. When giving ventilations to a child who is not breathing but has a definitive pulse,
you should give ventilations:
A | 2
every 5 to 6 seconds C | 1
every 3 seconds
B | 2
every 3 seconds D | 1
every 5 to 6 seconds
11. W
hat should you do if you are giving ventilations and the victim’s chest does not
rise after the first breath?
When giving ventilations, if the chest does not rise after the first breath, reopen the airway,
make a seal and try a second breath. If the breath is not successful, move to compressions
and check the airway for an obstruction before attempting subsequent ventilations. If an
obstruction is found, remove it and attempt ventilations. However, never perform a blind
finger sweep.
12. All of the following describe appropriate care for a conscious person with an
airway obstruction (choking) EXCEPT:
A | C
heck the victim for breathing and a pulse C | O
btain consent; if the victim is a child,
for no more than 10 seconds. get consent from a parent or guardian.
B | P
erform a combination of 5 back blows D | If the victim cannot cough, speak or
followed by 5 abdominal thrusts. breathe, activate the EAP and have
someone summon EMS.

13. If a conscious choking victim becomes unresponsive, what should you do?
■■ Carefully lower the victim to a firm, flat surface.

■■ Send someone to get an AED, and summon additional resources if appropriate and you
have not already done so.
■■ Immediately begin CPR with chest compressions.

Chapter 9 Review
1. Describe the five links in the Cardiac Chain of Survival for adults:
■■ Recognition of cardiac arrest and activation of the emergency response system.

■■ Early CPR to keep oxygen-rich blood flowing and to help delay brain damage and
death.
■■ Early defibrillation to help restore an effective heart rhythm and significantly increase the
patient’s chance for survival.
■■ Advanced life support using advanced medical personnel who can provide the proper
tools and medication needed to continue the lifesaving care.
■■ Integrated post-cardiac arrest care to optimize ventilation and oxygenation and treat
hypotension immediately after the return of spontaneous circulation.
2. Fill in the blank: For each minute CPR and defibrillation are delayed, the victim’s
chance for survival is reduced by about ____ percent.
3. What should you do if you think someone is having a heart attack?
■■ Take immediate action and summon EMS personnel.

■■ Have the victim stop any activity and rest in a comfortable position.
■■ Loosen tight or uncomfortable clothing.
■■ Closely monitor the victim until EMS personnel take over. Note any changes in the victim’s
appearance or behavior.
■■ Comfort the victim.
■■ Be prepared to perform CPR and use an AED.
4. Signs of cardiac arrest include (circle all that apply):
A | S
udden collapse D | Unresponsiveness
B | V
omiting E | Rapid pulse
C | N
o pulse

5. What is the objective of CPR?
To perform a combination of effective chest compressions and ventilations to circulate

blood that contains oxygen to the victim’s brain and other vital organs.
6. Fill in the blanks: Compressions given at the correct rate are at least ____
100 per minute
to a maximum of ____120 per minute.
7. What is the appropriate compression depth when providing CPR on an adult?

A | A
t least 2 inches but no more than C | 2
inches
2.4 inches
B | A
t least 2.4 inches but no more than D | 1½ inches
3 inches
8. When providing two-rescuer CPR, when should rescuers change positions?

A | At least every 2 minutes C | D
uring the analysis of the AED
B | A
fter 5 cycles of 30 compressions and D | All of the above
2 ventilations
9. You arrive on the scene when another lifeguard is performing CPR. What should
you do first?
Confirm that EMS personnel have been summoned. If EMS personnel have not been
summoned, do so before getting the AED or assisting with care.

10. W
hen performing two-rescuer CPR on an infant, describe how lifeguards should
modify the following:
Compression-to-ventilation ratio:
Change from (30:2) to (15:2). This provides more frequent ventilations for infants.
The compression technique:

Use the encircling thumbs technique.
11. Provide three examples why a lifeguard could or should stop CPR:

■■ Other trained responders, such as a member of your safety team or EMS personnel,
take over and relieve you from compression and ventilation responsibilities.
12. True or False: It is not appropriate to use an AED on a victim who is pregnant.
False
Why?
Defibrillation shocks transfer no significant electrical current to the fetus. The mother’s
survival is paramount to the infant’s survival.

Chapter 10 Review
1. When completing a secondary assessment, lifeguards use SAMPLE to gather a brief
history of the responsive victim. What does the mnemonic SAMPLE stand for?
S Signs and Symptoms
A Allergies
M Medications
P Pertinent past medical history
L Last oral intake
E Events leading up to the incident
2. List five symptoms of sudden illnesses:

■■ Changes in LOC, such as feeling light-headed, dizzy or becoming unconscious
■■ Nausea or vomiting
■■ Difficulty speaking or slurred speech
■■ Numbness or weakness
■■ Loss of vision or blurred vision
■■ Changes in breathing; the person may have trouble breathing or may not be
breathing normally
■■ Changes in skin color (pale, ashen or flushed skin)
■■ Sweating
■■ Persistent pressure or pain
■■ Diarrhea
■■ Paralysis or an inability to move
■■ Severe headache

3. List the general precautions for injury or sudden illness on land:
1) Care for any life-threatening conditions first.
2) Monitor the victim’s condition and watch for changes in LOC.
3) Keep the victim comfortable and reassure them.
4) Keep the victim from getting chilled or overheated.
5) Do not give the victim anything to eat or drink unless the victim is awake, able to
swallow and follow simple commands and intake is indicated based on the treatment
recommendations.
6) Care for any other problems that develop, such as vomiting.
4. How should you provide care for a victim experiencing a diabetic emergency?
If it is available, give 15 to 20 grams of sugar in the form of glucose tablets to the victim. If
not available, 15 to 20 grams of sugar from several sources can be given including glucose-
and sucrose-containing candies, jelly beans, orange juice or whole milk.
5. When would you summon EMS personnel for a victim of a diabetic emergency?
Provide two examples.

■■ The person is unresponsive.
■■ The person is responsive but not fully awake and unable to swallow.
■■ The person does not feel better within about 10 to 15 minutes after taking sugar or
gets worse.
■■ A form of sugar cannot be found immediately. Do not spend time looking for it.

6. List three reasons why you should summon EMS personnel for a victim who is
having, or had a seizure.

■■ The seizure occurs in the water.
■■ This is the person’s first seizure.
■■ The seizure lasts more than 5 minutes.
■■ The person has repeated seizures with no lucid period.
■■ The person appears to be injured.
■■ The cause of the seizure is unknown.
■■ The person is pregnant.
■■ The person is known to have diabetes.
■■ The person fails to regain consciousness after the seizure.
■■ The person is elderly and may have suffered a stroke.
7. You are lifeguarding at a crowded facility and recognize a patron in the water
who appears to be having a seizure. Place the following response and care steps in
order.
Remove the person from the water.

3
Perform a primary assessment.

4
Support the person with their head above water until the
2
seizure ends.
Summon EMS personnel.
1
If breathing normally, position the victim on their side and

5
monitor airway and breathing.
8. You are conducting a secondary assessment on an adult patron who lost their
balance on the pool deck. The patron is slurring his speech while explaining that
his arm is feeling numb. What sudden illness could this patron be experiencing?
A | Cardiac arrest C | Seizure
B | D
iabetic emergency D | Stroke

9. What does FAST stand for?
F Face
A Arms
S Speech
T Time
When would you use it?
Use this stroke screening scale to identify and care for a victim of stroke.
10. What are a lifeguard’s objectives while waiting for EMS personnel to arrive?
1) Care for any life-threatening conditions first.
2) Help the victim rest in a comfortable position and reassure them. If there are signs and
symptoms of shock, lie the person flat.
3) Monitor the victim’s condition and watch for any changes in LOC.
4) Keep the victim from getting chilled or overheated (care for shock).
5) Care for other problems that develop, such as vomiting.

11. The following are signs and symptoms of shock, EXCLUDING:
A | Altered level of consciousness C | Restlessness or irritability
B | W
arm or dry skin D | Nausea or vomiting
12. F Heat stroke

ill in the blank. _________________ is a life-threatening condition that occurs when
the body’s systems are overwhelmed by heat and stop functioning.
List three signs and symptoms of the condition described above:

■■ Changes in LOC
■■ Skin that is hot to the touch
■■ Skin that is wet or dry or appears red or pale
■■ Vision disturbances
■■ Seizures
■■ Vomiting
■■ Rapid and shallow breathing
■■ Rapid and weak pulse
■■ Lack of sweating

Chapter 11 Review
1. Head, neck or spinal injuries often are caused by high-impact/high-risk activities.
List three examples of high-impact/high-risk activities in an aquatic environment.

■■ Entering head-first into shallow water
■■ Falling from greater than a standing height
■■ Entering the water from a height, such as a diving board, water slide, an embankment,
cliff or tower
■■ Striking a submerged or floating object
■■ Receiving a blow to the head
■■ Colliding with another swimmer
■■ Striking the water with high impact, such as falling while water skiing or surfing
2. Place the general rescue procedures for caring for a head, neck or spinal injury in
the water in order:
Check for responsiveness and breathing.

4
Activate the EAP. 1
Perform a rescue providing manual in-line stabilization. 3
Re-assess the victim’s condition and provide appropriate care. 6
Safely enter the water. 2
Remove the victim from the water using the appropriate spinal 5
backboarding procedure.

head splint
3. Fill in the blank. The ________________________ technique is used for performing
manual in-line stabilization for victims in the water.
4. Backboards are a standard piece of rescue equipment used at aquatic facilities for
immobilizing and removing the victim from the water. Backboards work best when
they are equipped with:
1) A chest strap to secure the victim to the board.
2) A head-immobilizer device that can be attached to the top, or head-end, of the board.
5. You enter the water to rescue a victim with a suspected spinal injury. You determine
that the victim is not breathing. What should you do next?
A | R
emove the victim from the water using C | R
emove the victim water using a Modified
the Passive Victim Extrication technique. Spinal Backboarding procedure.
B | R
emove the victim from the water using D | Delay removal from the water and provide
the Spinal Backboarding procedure. 2 minutes of in-water ventilations.
6. The following statements describe appropriate rescue techniques for a victim with a
suspected spinal injury, EXCEPT:
A | If the victim is in shallow water, you do C | If the victim is small and is in shallow water,
not need to use a rescue tube to support you do not need to use a backboard to
yourself. extricate the victim.
B | If the victim is submerged, you should not D | If the victim is at the surface in deep water,
use the rescue tube when submerging and you may need a rescue tube to support
bringing the victim to the surface. yourself and the victim.

7. When rescuing a victim of a suspected head, neck or spinal injury using the spinal
backboarding procedure, communication with the victim is important. What should
lifeguards tell the victim?
Answers include:
■■ Let the victim know what you are doing.
■■ Reassure the victim along the way.
■■ Tell the victim not to nod or shake their head but instead say “yes” or “no” to answer
questions.
8. Describe four ways that additional lifeguards can help during spinal backboarding
and extrication from the water.
Answers should include four of the following:

■■ Helping to submerge, position and stabilize the backboard on deck
■■ Supporting the in-water rescuer in deep water
■■ Supporting the backboard while the chest strap and head-immobilizer are secured.
■■ Securing the chest strap or the head-immobilizer device
■■ Communicating with and reassuring the victim
■■ Guiding the backboard as it is being removed from the water
■■ Removing the backboard from the water
■■ Providing care after the victim has been removed from the water

1. Special considerations for spinal injuries at a facility with a beach or other

zero-depth entry may include:
A | Injury from board diving and extrication C | Injury from plunging during a running entry,
from deep water onto a pier high above in-line stabilization and extrication from
the water. extremely shallow water.
B | Injury from exiting a slide and dealing with D | Injury

from fall from play structure, dealing
current in a catch pool. with victim’s life jacket during stabilization
and extrication.
2. How should lifeguards extricate a suspected spinal injury victim who is secured to
a backboard from a zero-depth or sloping entry waterfront?
After reaching the zero-depth entry, the lifeguards slightly lift the head-end of the
backboard, carefully pulling the backboard and victim out of the water. Gently lower the
backboard and victim to the ground once out of water using proper lifting techniques to
prevent injury.

1. How should lifeguards extricate a suspected spinal injury victim who is secured to
a backboard from a zero-depth entry wave pool?
After reaching the zero-depth entry, the lifeguards slightly lift the head-end of the backboard,
carefully pulling the backboard and victim out of the water. Gently lower the backboard and
victim to the ground once out of water using proper lifting techniques to prevent injury.
2. When rescuing a suspected head, neck or spinal injury victim from a winding river
or other moving water attraction, moving water and objects in the water can pull
or move the victim. What should be done to help minimize movement and protect
the victim?
Answers include:
■■ Push the emergency stop button.
■■ Ask other lifeguards or patrons for help in keeping objects and people from floating into
the rescuer while they are supporting the victim.
■■ Keep the victim’s head pointed upstream.
■■ Place the victim on a backboard by following the facility’s spinal backboarding procedure.

3. What actions should lifeguards take when responding to a victim with a suspected
head, neck or spinal injury in a catch pool?
■■ Immediately signal to other lifeguards or dispatchers to stop sending riders.

■■ If possible, stop the flow of water by pushing the emergency stop button.
■■ Once in-line stabilization is achieved and the victim is turned face-up, move the victim to
the calmest water in the catch pool if water is still flowing. If several slides empty into the
same catch pool, calmer water usually is between two slides.
■■ Place the victim on a backboard by following the facility’s spinal backboarding
procedure.
4. What challenges might you encounter when responding to a head, neck or spinal
injury in a waterpark? Consider different attractions such as a wave pool, winding
river, speed slide, etc.
Answers include:
■■ Water movement (current or waves)
■■ Ride vehicles
■■ Tight spaces such as steps on a tower or walls on a speed slide

QUATIC ATTRACTION LIFEGUARDING
A
SECTION D | SKILL CHARTS AND ASSESSMENTS
AQUATIC ATTRACTION LIFEGUARDING (WATER ≤ 3’) SKILL

CHARTS AND ASSESSMENT TOOLS
criteria listed at the proficient level to be checked off for this skill.
This outline includes the skill charts and skill assessment tools for the Aquatic Attraction Lifeguarding
(Water ≤ 3’) specific skills:
■■ Passive Victim at or Near the Surface In Water ≤ 3’, Face-Up
■■ Passive Victim at or Near the Surface In Water ≤ 3’, Face-Down
Use the skill charts and skill assessment tools at the end of each lesson (in Section B) when conducting
and evaluating all other skills in this course.
SKILL CHART: PASSIVE VICTIM AT OR NEAR THE SURFACE IN WATER ≤ 3’, FACE-UP
1. Swim or quickly walk to the victim’s side. If you are using a rescue tube, let go of it but keep
the strap around your shoulder.
2. Reach down to grasp the victim’s arms midway between the elbows and shoulders. Move the
victim’s arms up alongside the victim’s head.
3. Grab the rescue tube, if you are using one, and position it under the victim’s shoulders.
The victim’s head should naturally fall back into an open-airway position. If the victim is
unresponsive, quickly check for breathing.
■■ If an assisting responder is available to assist with extrication, remove the victim from the water
without positioning the rescue tube under the victim’s shoulders.
4. Move the victim to a safe exit point, remove the victim from the water, assess the victim’s
condition and provide appropriate care.
SKILL CHART: PASSIVE VICTIM AT OR NEAR THE SURFACE IN WATER ≤ 3’, FACE-DOWN
1. Swim or quickly walk to the victim’s side. If you are using a rescue tube, let go of it but keep the
strap around your shoulder.
2. Reach down to grasp the victim’s arms midway between the elbows and shoulders. Move the
victim’s arms up alongside the victim’s head.
3. Glide the victim forward and roll the victim face-up by pushing the victim’s arm that is closest to
you under the water while pulling the victim’s other arm across the surface toward you.
■■ If the water is too shallow to glide the victim forward without causing further injury, roll the victim
to a face-up position by simultaneously lifting and rolling the victim over.
4. Grab the rescue tube, if you are using one, and position it under the victim’s shoulders. The victim’s
head should naturally fall back into an open-airway position. If the victim is unresponsive, quickly
check for breathing.
■■ If an assisting responder is available to assist with extrication, remove the victim from the water
without positioning the rescue tube under the victim’s shoulders.
5. Move the victim to a safe exit point, remove the victim from the water, assess the victim’s condition
and provide appropriate care.

SKILL ASSESSMENT TOOL: PASSIVE VICTIM AT OR NEAR THE SURFACE IN WATER ≤ 3’
Victim’s mouth and nose ■■ Maintains victim’s mouth and ■■ Does not maintain victim’s
remain above water nose above water mouth or nose above water
Victim is moved to a safe ■■ Moves victim to a safe exit ■■ Is unable to move the victim
exit point point using the rescue tube or a to a safe exit point.
backboard to support ■■ Victim is not supported by
the victim the rescue tube or backboard
(if used) and slips off or
submerges
victim
Victim’s head is maintained in ■■ Places rescue tube under the ■■ Victim’s head is tilted forward
an open-airway position at victim’s shoulders so that the (chin toward chest)
the surface. victim’s head falls back to an
open airway position*

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Lifeguarding

The following materials (including downloadable electronic materials, as applicable),

■■ The Recipient is prohibited from revising, altering, adapting or modifying the

■■ The Recipient is prohibited from removing these Terms and Conditions in

To request permission to reproduce or publish Red Cross materials, please submit an

Printed in the United States of America

ii Lifeguarding | Blended Learning Instructor’s Manual

The following members of the American Red Cross Scientific Advisory

David Markenson, MD, MBA, FCCM, FAAP,

Peter G. Wernicki, MD, FAAOS

Teresa (Terri) Lees, MS

Linda Quan, MD, FAAP

iii Lifeguarding | Blended Learning Instructor’s Manual

Angela Beale, PhD

For more information on the Scientific Advisory Council, visit

The American Red Cross thanks:

iv Lifeguarding | Blended Learning Instructor’s Manual

Algreatus Batton, AFO

David W. Bell, PhD

William A.J. Kirkner, JD

v Lifeguarding | Blended Learning Instructor’s Manual

Christopher R. Whipple, AqP

vi Lifeguarding | Blended Learning Instructor’s Manual

vii Lifeguarding | Blended Learning Instructor’s Manual

Chapter 1: Program Overview . . . . . . . . . . . . . 2

LIFEGUARDING BLENDED LEARNING LESSON 1

ix Lifeguarding | Blended Learning Instructor’s Manual

Injury Prevention . . . . . . . . . . . . . . . . . . . . . . . . 76 Before Providing Care, Victim Assessment

x Lifeguarding | Blended Learning Instructor’s Manual

Cardiac Emergencies and Using an

xi Lifeguarding | Blended Learning Instructor’s Manual

Appendix A: Sample Letters . . . . . . . . . . . . . 194 Appendix F: About the Science . . . . . . . . . . 236

Aquatic Attraction Lifeguarding (Water ≤ 3’)

xii Lifeguarding | Blended Learning Instructor’s Manual

2 Lifeguarding | Blended Learning Instructor’s Manual

3 Lifeguarding | Blended Learning Instructor’s Manual

■■ Participants could represent a broad range of backgrounds.

4 Lifeguarding | Blended Learning Instructor’s Manual

5 Lifeguarding | Blended Learning Instructor’s Manual

Aquatic Complete the water n/a Complete a timed event within 50

6 Lifeguarding | Blended Learning Instructor’s Manual

PROGRAM COURSES AND MODULES

PROGRAM DELIVERY METHODS

PROGRAM INSTRUCTIONAL DESIGN

7 Lifeguarding | Blended Learning Instructor’s Manual

8 Lifeguarding | Blended Learning Instructor’s Manual

American Red Cross Lifeguarding Manual

Online Content for Lifeguarding Blended Learning Course

9 Lifeguarding | Blended Learning Instructor’s Manual

10 Lifeguarding | Blended Learning Instructor’s Manual

THE RED CROSS LEARNING CENTER

11 Lifeguarding | Blended Learning Instructor’s Manual

12 Lifeguarding | Blended Learning Instructor’s Manual

13 Lifeguarding | Blended Learning Instructor’s Manual

Eligibility to Teach Other American Red Cross Programs

Available instructor bridge course options (depending on program):

Additional basic-level certifications may be necessary in addition to completing an instructor bridge

14 Lifeguarding | Blended Learning Instructor’s Manual

MAINTAINING CONSISTENT TRAINING STANDARDS